1
|
Fang F, Hughes TF, Weinstein A, Dodge HH, Jacobsen EP, Chang CCH, Snitz BE, Ganguli M. Social Isolation and Loneliness in a Population Study of Cognitive Impairment: The MYHAT Study. J Appl Gerontol 2023; 42:2313-2324. [PMID: 37518906 PMCID: PMC10825064 DOI: 10.1177/07334648231192053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
In this study, we examined associations of social isolation and loneliness with cognitive impairment among older adults from a Rust Belt region in Southwest Pennsylvania. We used data from the population-based Monongahela-Youghiogheny Healthy Aging Team (MYHAT) study. We found that (a) 11 items combined into two reliable composites of social isolation and loneliness; (b) unique to this study, providing unpaid help to others was an indicator of reduced social isolation; (c) social isolation and loneliness were positively associated with cognitive impairment; and (d) these associations were appreciably attenuated by general health and physical functional status and depressive symptoms, respectively. We concluded that social isolation and loneliness are differentially associated with older adults' cognitive health, and that their effects might operate through separate pathways. Approaches to address social isolation and loneliness should consider the community context and its implications for older adults' cognitive health.
Collapse
Affiliation(s)
- Fang Fang
- Research and Infrastructure Research Service (RISE) and Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Tiffany F. Hughes
- Department of Graduate Studies in Health and Rehabilitation Sciences, Bitonte College of Health and Human Services, Youngstown State University, Youngstown, OH, USA
| | - Andrea Weinstein
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hiroko H. Dodge
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Erin P. Jacobsen
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chung-Chou H. Chang
- Department of Medicine, and Department of Biostatistics, School of Medicine and School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Beth E. Snitz
- Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary Ganguli
- Departments of Psychiatry, Neurology, and Epidemiology, School of Medicine and School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
2
|
Mahalingam G, Samtani S, Lam BCP, Lipnicki DM, Lima-Costa MF, Blay SL, Castro-Costa E, Shifu X, Guerchet M, Preux PM, Gbessemehlan A, Skoog I, Najar J, Sterner TR, Scarmeas N, Yannakoulia M, Riedel-Heller S, Dardiotis T, Röhr S, Kim KW, Pabst A, Shahar S, Numbers K, Ganguli M, Hughes TF, Chang CCH, Crowe M, Ng TP, Gwee X, Chua DQL, Rymaszewska J, Wolf-Ostermann K, Welmer AK, Stafford J, Mélis R, Vernooij-Dassen M, Jeon YH, Sachdev PS, Brodaty H. Social connections and risk of incident mild cognitive impairment, dementia, and mortality in 13 longitudinal cohort studies of ageing. Alzheimers Dement 2023; 19:5114-5128. [PMID: 37102417 PMCID: PMC10603208 DOI: 10.1002/alz.13072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Previous meta-analyses have linked social connections and mild cognitive impairment, dementia, and mortality. However, these used aggregate data from North America and Europe and examined a limited number of social connection markers. METHODS We used individual participant data (N = 39271, Mage = 70.67 (40-102), 58.86% female, Meducation = 8.43 years, Mfollow-up = 3.22 years) from 13 longitudinal ageing studies. A two-stage meta-analysis of Cox regression models examined the association between social connection markers with our primary outcomes. RESULTS We found associations between good social connections structure and quality and lower risk of incident mild cognitive impairment (MCI); between social structure and function and lower risk of incident dementia and mortality. Only in Asian cohorts, being married/in a relationship was associated with reduced risk of dementia, and having a confidante was associated with reduced risk of dementia and mortality. DISCUSSION Different aspects of social connections - structure, function, and quality - are associated with benefits for healthy aging internationally. HIGHLIGHTS Social connection structure (being married/in a relationship, weekly community group engagement, weekly family/friend interactions) and quality (never lonely) were associated with lower risk of incident MCI. Social connection structure (monthly/weekly friend/family interactions) and function (having a confidante) were associated with lower risk of incident dementia. Social connection structure (living with others, yearly/monthly/weekly community group engagement) and function (having a confidante) were associated with lower risk of mortality. Evidence from 13 longitudinal cohort studies of ageing indicates that social connections are important targets for reducing risk of incident MCI, incident dementia, and mortality. Only in Asian cohorts, being married/in a relationship was associated with reduced risk of dementia, and having a confidante was associated with reduced risk of dementia and mortality.
Collapse
Affiliation(s)
- Gowsaly Mahalingam
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, UNSW Sydney, Australia
| | - Suraj Samtani
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, UNSW Sydney, Australia
| | - Ben Chun Pan Lam
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, UNSW Sydney, Australia
- School of Psychology and Public Health, La Trobe University Melbourne, UNSW Sydney, Australia
| | - Darren M Lipnicki
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, UNSW Sydney, Australia
| | - Maria Fernanda Lima-Costa
- Center for Studies in Public Health and Aging’ René Rachou Research Center, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | - Sergio Luis Blay
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, São Paulo, Brazil
| | - Erico Castro-Costa
- Center for Studies in Public Health and Aging’ René Rachou Research Center, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | - Xiao Shifu
- Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Maëlenn Guerchet
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT – Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Pierre-Marie Preux
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT – Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Antoine Gbessemehlan
- Inserm U1094, IRD UMR270, Univ. Limoges, CHU Limoges, EpiMaCT – Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Ingmar Skoog
- Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, Centre for Ageing and Health (AGECAP), at the University of Gothenburg, Mölndal, Sweden
- Region Västra Götaland, Psychiatry, Cognition and Old Age Psychiatry Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jenna Najar
- Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, Centre for Ageing and Health (AGECAP), at the University of Gothenburg, Mölndal, Sweden
- Region Västra Götaland, Psychiatry, Cognition and Old Age Psychiatry Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Therese Rydberg Sterner
- Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, Centre for Ageing and Health (AGECAP), at the University of Gothenburg, Mölndal, Sweden
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, New York, USA
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Steffi Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | | | - Susanne Röhr
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Faculty of Medicine, University of Leipzig, Leipzig, Germany
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
- Health and Ageing Research Team, School of Psychology, Massey University, Palmerston, New Zealand
| | - Ki-Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
- Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, South Korea
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Suzana Shahar
- Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Katya Numbers
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, UNSW Sydney, Australia
| | - Mary Ganguli
- Departments of Psychiatry, Epidemiology, and Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Chung-Chou H. Chang
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tze Pin Ng
- Yong Loo Lin School of Medicine, Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
| | - Xinyi Gwee
- Yong Loo Lin School of Medicine, Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
| | - Denise Qian Ling Chua
- Yong Loo Lin School of Medicine, Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
| | | | - Karin Wolf-Ostermann
- Department of Health Services and Nursing Science Research, Institute for Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
| | - Anna-Karin Welmer
- Aging Research Center & Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Jean Stafford
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - René Mélis
- Department of Geriatrics, Radboud University Medical Centre, Nijmegen, Gelderland, The Netherlands
| | | | - Yun-Hee Jeon
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, UNSW Sydney, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, UNSW Sydney, Australia
| |
Collapse
|
3
|
Wu W, Ding D, Zhao Q, Xiao Z, Luo J, Ganguli M, Hughes TF, Jacobsen E, Haan MN, van Dang K, Lima-Costa MF, Blay SL, de Castro-Costa E, Ng TP, Gwee X, Gao Q, Gureje O, Ojagbemi A, Bello T, Shahar S, Ludin AFM, Rivan NFM, Scarmeas N, Anastasiou CA, Yannakoulia M, Brodaty H, Crawford JD, Lipton RB, Derby CA, Katz MJ, Lipnicki DM, Sachdev PS. Dose-response relationship between late-life physical activity and incident dementia: A pooled analysis of 10 cohort studies of memory in an international consortium. Alzheimers Dement 2023; 19:107-122. [PMID: 35290713 PMCID: PMC9652610 DOI: 10.1002/alz.12628] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/22/2022] [Accepted: 01/24/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Though consistent evidence suggests that physical activity may delay dementia onset, the duration and amount of activity required remains unclear. METHODS We harmonized longitudinal data of 11,988 participants from 10 cohorts in eight countries to examine the dose-response relationship between late-life physical activity and incident dementia among older adults. RESULTS Using no physical activity as a reference, dementia risk decreased with duration of physical activity up to 3.1 to 6.0 hours/week (hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.67 to 1.15 for 0.1 to 3.0 hours/week; HR 0.68, 95% CI 0.52 to 0.89 for 3.1 to 6.0 hours/week), but plateaued with higher duration. For the amount of physical activity, a similar pattern of dose-response curve was observed, with an inflection point of 9.1 to 18.0 metabolic equivalent value (MET)-hours/week (HR 0.92, 95% CI 0.70 to 1.22 for 0.1 to 9.0 MET-hours/week; HR 0.70, 95% CI 0.53 to 0.93 for 9.1 to 18.0 MET-hours/week). DISCUSSION This cross-national analysis suggests that performing 3.1 to 6.0 hours of physical activity and expending 9.1 to 18.0/MET-hours of energy per week may reduce dementia risk.
Collapse
Affiliation(s)
- Wanqing Wu
- Institute of Neurology, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ding Ding
- Institute of Neurology, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Qianhua Zhao
- Institute of Neurology, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhenxu Xiao
- Institute of Neurology, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianfeng Luo
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Mary Ganguli
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, USA
| | - Tiffany F Hughes
- Department of Health Professions, Youngstown State University, OH, USA
| | - Erin Jacobsen
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, USA
| | - Mary N Haan
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, USA
| | - Kristine van Dang
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, USA
| | - Maria Fernanda Lima-Costa
- Center for Studies in Public Health and Aging’ René Rachou Research Center, Oswaldo Cruz Foundation, Belo Horizonte, Brazil
| | - Sergio Luis Blay
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Erico de Castro-Costa
- Center for Studies in Public Health and Aging’ René Rachou Research Center, Oswaldo Cruz Foundation, Belo Horizonte, Brazil
| | - Tze Pin Ng
- Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
| | - Xinyi Gwee
- Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
| | - Qi Gao
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore, Singapore
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Akin Ojagbemi
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Toyin Bello
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Suzana Shahar
- Dietetic Program, Centre for Healthy Aging, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Arimi Fitri Mat Ludin
- Biomedical Science Program, Centre for Healthy Aging, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nurul Fatin Malek Rivan
- Nutritional Sciences Program, Centre for Healthy Aging, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | | | - Mary Yannakoulia
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - John D Crawford
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, New York, USA
| | - Carol A Derby
- Department of Neurology, Albert Einstein College of Medicine, New York, USA
| | - Mindy J Katz
- Department of Neurology, Albert Einstein College of Medicine, New York, USA
| | - Darren M Lipnicki
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | | |
Collapse
|
4
|
Hughes TF, Ran X, Fang F, Jacobsen E, Snitz BE, Chang CCH, Ganguli M. Psychosocial implications of early COVID-19 restrictions on older adults in a small-town region in Southwestern, Pennsylvania (USA). Int Psychogeriatr 2022:1-10. [PMID: 36352761 DOI: 10.1017/s1041610222000977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The restrictions put in place in 2020 to mitigate the spread of the coronavirus disease 2019 limited or eliminated social connections that are vital for psychosocial well-being. The objectives of this research were to examine the impact of early pandemic-related restrictions on feelings of loneliness, depression, and anxiety as well as social activity disruption and their concomitant associations in a sample of community-dwelling older adults residing in a small-town region in the USA. DESIGN AND SETTING Cross-sectional data collected from an ongoing population-based cohort study in Southwestern, Pennsylvania. PARTICIPANTS Analyses included 360 adults aged 65 years and older whose annual study assessment occurred during the first 120 days of pandemic-related restrictions. MEASUREMENTS Self-reported feelings of loneliness, depression, and anxiety due to the pandemic-related restrictions were each measured using a single question. Depressive symptoms and anxiety were also assessed with the modified Center for Epidemiologic Studies-Depression and Generalized Anxiety Disorder-7 item tools. Disruption in a variety of common social activities was also assessed. RESULTS Feeling lonely affected 36% of participants who were more likely to be female, not currently married, and living alone. Giving up in-person visits with family was associated with significantly higher odds of feeling lonely, and feeling lonely was associated with significantly higher odds of feelings of anxiety and depression. CONCLUSIONS Loneliness is a serious outcome of pandemic-related restrictions among older adults, potentially linked to loss of connection with family, and may be associated with increased feelings of depression and anxiety.
Collapse
Affiliation(s)
- Tiffany F Hughes
- Department of Graduate Studies in Health and Rehabilitation Sciences, Youngstown State University, One University Plaza, Youngstown, OH44555, USA
| | - Xinhui Ran
- Department of Biostatistics, School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA15261, USA
| | - Fang Fang
- EVMS-Sentar Health Analytics and Delivery Science Institute, Eastern Virginia Medical School, 855 W. Brambleton Avenue, Norfolk, VA23510, USA
| | - Erin Jacobsen
- Department of Psychiatry, School of Medicine, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA15261, USA
| | - Beth E Snitz
- Department of Neurology, School of Medicine, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA15261, USA
| | - Chung-Chou H Chang
- Department of Biostatistics, School of Public Health, and Department of Medicine, School of Medicine, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA15261, USA
| | - Mary Ganguli
- Departments of Psychiatry and Neurology, School of Medicine, and Department of Epidemiology, School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA15261, USA
| |
Collapse
|
5
|
Hyun J, Hall CB, Katz MJ, Derby CA, Lipnicki DM, Crawford JD, Guaita A, Vaccaro R, Davin A, Kim KW, Han JW, Bae JB, Röhr S, Riedel-Heller S, Ganguli M, Jacobsen E, Hughes TF, Brodaty H, Kochan NA, Trollor J, Lobo A, Santabarbara J, Lopez-Anton R, Sachdev PS, Lipton RB. Education, Occupational Complexity, and Incident Dementia: A COSMIC Collaborative Cohort Study. J Alzheimers Dis 2021; 85:179-196. [PMID: 34776437 DOI: 10.3233/jad-210627] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Education and occupational complexity are main sources of mental engagement during early life and adulthood respectively, but research findings are not conclusive regarding protective effects of these factors against late-life dementia. OBJECTIVE This project aimed to examine the unique contributions of education and occupational complexity to incident dementia, and to assess the mediating effects of occupational complexity on the association between education and dementia across diverse cohorts. METHOD We used data from 10,195 participants (median baseline age = 74.1, range = 58∼103), representing 9 international datasets from 6 countries over 4 continents. Using a coordinated analysis approach, the accelerated failure time model was applied to each dataset, followed by meta-analysis. In addition, causal mediation analyses were performed. RESULT The meta-analytic results indicated that both education and occupational complexity were independently associated with increased dementia-free survival time, with 28%of the effect of education mediated by occupational complexity. There was evidence of threshold effects for education, with increased dementia-free survival time associated with 'high school completion' or 'above high school' compared to 'middle school completion or below'. CONCLUSION Using datasets from a wide range of geographical regions, we found that both early life education and adulthood occupational complexity were independently predictive of dementia. Education and occupational experiences occur during early life and adulthood respectively, and dementia prevention efforts could thus be made at different stages of the life course.
Collapse
Affiliation(s)
- Jinshil Hyun
- Saul R. Korey Department of Neurology, AlbertEinstein College of Medicine, Bronx, NY, USA
| | - Charles B Hall
- Saul R. Korey Department of Neurology, AlbertEinstein College of Medicine, Bronx, NY, USA.,Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mindy J Katz
- Saul R. Korey Department of Neurology, AlbertEinstein College of Medicine, Bronx, NY, USA
| | - Carol A Derby
- Saul R. Korey Department of Neurology, AlbertEinstein College of Medicine, Bronx, NY, USA
| | - Darren M Lipnicki
- Centre for Healthy Brain Ageing, University of NewSouth Wales, Sydney, New South Wales, Australia
| | - John D Crawford
- Centre for Healthy Brain Ageing, University of NewSouth Wales, Sydney, New South Wales, Australia
| | | | | | | | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul NationalUniversity Bundang Hospital, Seongnam, South Korea
| | - Ji Won Han
- Department of Psychiatry, College of Medicine, Seoul National University, Seoul, South Korea
| | - Jong Bin Bae
- Department of Brain & Cognitive Sciences, SeoulNational University, Seoul, South Korea
| | - Susanne Röhr
- Instituteof Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany.,GlobalBrain Health Institute (GBHI), Trinity College Dublin, Dublin, Ireland
| | - Steffi Riedel-Heller
- Instituteof Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | | | | | | | - Henry Brodaty
- Centre for Healthy Brain Ageing, University of NewSouth Wales, Sydney, New South Wales, Australia.,Dementia Collaborative Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing, University of NewSouth Wales, Sydney, New South Wales, Australia
| | - Julian Trollor
- Centre for Healthy Brain Ageing, University of NewSouth Wales, Sydney, New South Wales, Australia.,Department of Developmental DisabilityNeuropsychiatry, School of Psychiatry, University of New SouthWales, Sydney, New South Wales, Australia
| | - Antonio Lobo
- Instituto de Investigación SanitariaAragón, Zaragoza, Spain.,Centro deInvestigación Biomédica en Red de Salud Mental, Ministry ofScience and Innovation, Spain.,Department ofMedicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
| | - Javier Santabarbara
- Instituto de Investigación SanitariaAragón, Zaragoza, Spain.,Centro deInvestigación Biomédica en Red de Salud Mental, Ministry ofScience and Innovation, Spain.,Department of Preventive Medicine and PublicHealth, University of Zaragoza, Zaragoza, Spain
| | - Raul Lopez-Anton
- Instituto de Investigación SanitariaAragón, Zaragoza, Spain.,Centro deInvestigación Biomédica en Red de Salud Mental, Ministry ofScience and Innovation, Spain.,Department of Psychology and Sociology, Universidad de Zaragoza, Teruel, Spain
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, University of NewSouth Wales, Sydney, New South Wales, Australia.,Dementia Collaborative Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Richard B Lipton
- Saul R. Korey Department of Neurology, AlbertEinstein College of Medicine, Bronx, NY, USA.,Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | | |
Collapse
|
6
|
Ganguli M, Hughes TF, Jia Y, Lingler J, Jacobsen E, Chang CCH. Aging and Functional Health Literacy: A Population-based Study. Am J Geriatr Psychiatry 2021; 29:972-981. [PMID: 33349506 PMCID: PMC8197766 DOI: 10.1016/j.jagp.2020.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 09/11/2020] [Revised: 10/23/2020] [Accepted: 12/08/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate functional health literacy and its associated factors among older adults drawn from a disadvantaged area. DESIGN Cross-sectional epidemiologic study. SETTING Population-based cohort randomly selected from the voter registration lists. PARTICIPANTS Individuals aged 65+ (N=1066). MEASUREMENTS The Short Test of Functional Health Literacy in Adults (S-TOFHLA); demographics; self-rated health; number of prescription drugs; modified Center for Epidemiologic Studies- Depression scale; Mini-Mental State Examination; Wechsler Test of Adult Reading; Clinical Dementia Rating; cognitive domain composite scores; independence in Instrumental Activities of Daily Living and medication management; health services utilization (emergency/urgent care visits and hospitalizations). RESULTS Low (inadequate or marginal) S-TOFHLA scores were obtained by 7.04% of the sample. In unadjusted analyses, participants with low S-TOFHLA scores were significantly more likely than those with higher scores to be older, male, non-White, with lesser education and lower household income, to have lower scores on the Wechsler Test of Adult Reading, the Mini-Mental State Examination, and all cognitive domains; to be more dependent in Instrumental Activities of Daily Living and be taking more prescription drugs. In a multiple regression model including all covariates, only older age, male sex, and lower reading level were independently associated with inadequate or marginal S-TOFHLA scores. CONCLUSION In a population-based sample of older adults, low functional health literacy was associated with age, sex, education, and reading ability. Basic functional health literacy is essential for understanding health information and instructions. Clinicians should formally or informally assess health literacy in their older patients to ensure effective communication and enhance health outcomes.
Collapse
Affiliation(s)
- Mary Ganguli
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
| | - Tiffany F. Hughes
- Department of Health Professions, Bitonte College of Health and Human Services, Youngstown State University, Youngstown, OH
| | - Yichen Jia
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Jennifer Lingler
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA,Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, PA,Clinical and Translational Science Institute, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Erin Jacobsen
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Chung-Chou H. Chang
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA,Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
7
|
Makkar SR, Lipnicki DM, Crawford JD, Kochan NA, Castro-Costa E, Lima-Costa MF, Diniz BS, Brayne C, Stephan B, Matthews F, Llibre-Rodriguez JJ, Llibre-Guerra JJ, Valhuerdi-Cepero AJ, Lipton RB, Katz MJ, Wang C, Ritchie K, Carles S, Carriere I, Scarmeas N, Yannakoulia M, Kosmidis M, Lam L, Chan WC, Fung A, Guaita A, Vaccaro R, Davin A, Kim KW, Han JW, Suh SW, Riedel-Heller SG, Roehr S, Pabst A, Ganguli M, Hughes TF, Snitz B, Anstey KJ, Cherbuin N, Easteal S, Haan MN, Aiello AE, Dang K, Pin Ng T, Gao Q, Zin Nyunt MS, Brodaty H, Trollor JN, Leung Y, Lo JW, Sachdev P. APOE ε4 and the Influence of Sex, Age, Vascular Risk Factors, and Ethnicity on Cognitive Decline. J Gerontol A Biol Sci Med Sci 2021; 75:1863-1873. [PMID: 32396611 DOI: 10.1093/gerona/glaa116] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 08/22/2019] [Indexed: 01/08/2023] Open
Abstract
We aimed to examine the relationship between Apolipoprotein E ε4 (APOE*4) carriage on cognitive decline, and whether these associations were moderated by sex, baseline age, ethnicity, and vascular risk factors. Participants were 19,225 individuals aged 54-103 years from 15 longitudinal cohort studies with a mean follow-up duration ranging between 1.2 and 10.7 years. Two-step individual participant data meta-analysis was used to pool results of study-wise analyses predicting memory and general cognitive decline from carriage of one or two APOE*4 alleles, and moderation of these associations by age, sex, vascular risk factors, and ethnicity. Separate pooled estimates were calculated in both men and women who were younger (ie, 62 years) and older (ie, 80 years) at baseline. Results showed that APOE*4 carriage was related to faster general cognitive decline in women, and faster memory decline in men. A stronger dose-dependent effect was observed in older men, with faster general cognitive and memory decline in those carrying two versus one APOE*4 allele. Vascular risk factors were related to an increased effect of APOE*4 on memory decline in younger women, but a weaker effect of APOE*4 on general cognitive decline in older men. The relationship between APOE*4 carriage and memory decline was larger in older-aged Asians than Whites. In sum, APOE*4 is related to cognitive decline in men and women, although these effects are enhanced by age and carriage of two APOE*4 alleles in men, a higher numbers of vascular risk factors during the early stages of late adulthood in women, and Asian ethnicity.
Collapse
Affiliation(s)
- Steve R Makkar
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Darren M Lipnicki
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - John D Crawford
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | | | | | - Breno Satler Diniz
- Department of Psychiatry, Faculty of Medicine University Toronto, Ontario, Canada.,Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Carol Brayne
- Department of Public Health and Primary Care, Cambridge University, UK
| | - Blossom Stephan
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Matthews
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Jorge J Llibre-Guerra
- Institute of Neurology and Neurosurgery, Havana, Cuba.,Memory and Aging Center, UCSF, San Francisco, California
| | | | - Richard B Lipton
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, New York City, New York
| | - Mindy J Katz
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, New York City, New York
| | - Cuiling Wang
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, New York City, New York
| | - Karen Ritchie
- Inserm, U1061 Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, Montpellier Cedex 5, France.,Université de Montpellier, Montpellier, France
| | - Sophie Carles
- Inserm, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Paris, France.,Paris Descartes University, Paris, France
| | - Isabelle Carriere
- Inserm, U1061 Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, Montpellier Cedex 5, France.,Université de Montpellier, Montpellier, France
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece.,Taub Institute for Research in Alzheimer's disease and the Aging Brain, Gertrude H Sergievsky Center, Department of Neurology, Columbia University, New York city, New York
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics (M.Y.), Harokopio University, Athens, Greece
| | - Mary Kosmidis
- Laboratory of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Linda Lam
- Department of Psychiatry, The Chinese University of Hong Kong
| | - Wai Chi Chan
- Department of Psychiatry, The Chinese University of Hong Kong
| | - Ada Fung
- Department of Applied Social Sciences, The Hong Kong Polytechnic University
| | | | | | | | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Psychiatry, Seoul National University, College of Medicine, Seoul, Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung Wan Suh
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Susanne Roehr
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Mary Ganguli
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Tiffany F Hughes
- Department of Sociology, Anthropology, and Gerontology, Youngstown State University, Youngstown, Ohio
| | - Beth Snitz
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kaarin J Anstey
- Neuroscience Research Australia, Sydney, Australia.,Centre for Research on Ageing, Health and Wellbeing, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Nicolas Cherbuin
- Centre for Research on Ageing, Health and Wellbeing, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Simon Easteal
- John Curtin School of Medical Research, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Mary N Haan
- University of California, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, California
| | - Allison E Aiello
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina.,Carolina Population Center, Chapel Hill, North Carolina
| | - Kristina Dang
- University of California, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, California
| | - Tze Pin Ng
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Qi Gao
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ma Shwe Zin Nyunt
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia.,Dementia Collaborative Research Centre, University of New South Wales Sydney, Sydney, Australia
| | - Julian N Trollor
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia.,Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Australia
| | - Yvonne Leung
- School of Psychology, University of Nottingham Malaysia, Semenyih, Malaysia
| | - Jessica W Lo
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Perminder Sachdev
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia.,Dementia Collaborative Research Centre, University of New South Wales Sydney, Sydney, Australia
| |
Collapse
|
8
|
Hughes TF, Liu A, Jacobsen E, Rosano C, Berman SB, Chang CCH, Ganguli M. Exercise and the Risk of Mild Cognitive Impairment: Does the Effect Depend on Vascular Factors? Alzheimer Dis Assoc Disord 2021; 35:30-35. [PMID: 32960854 PMCID: PMC9350907 DOI: 10.1097/wad.0000000000000410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 08/21/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Although exercise is associated with a lower risk for mild cognitive impairment (MCI), it is unclear whether its protective effect depends on the presence or absence of vascular factors. METHODS In an exploratory study of data from a population-based cohort, 1254 participants aged 65+ years were followed for 10 years for incident MCI. The main effect of baseline total minutes of exercise per week (0 vs. 1 to 149 vs. 150+), and its interaction with several vascular factors, on risk for incident MCI was examined using Cox proportional hazards regression models, adjusting for demographics. RESULTS Compared with no exercise, 1 to 149 minutes [hazard ratio (HR)=0.90; 95% confidence interval (95% CI), 0.69-1.16] and 150 or more minutes per week (HR=0.84; 95% CI, 0.66-1.07) of exercise lowered risk for incident MCI in a dose-dependent manner. The majority of interactions were not statistically significant, but risk reduction effect sizes of <0.75 suggested that exercise may have stronger effects among those without high cholesterol, never smoking, and not currently consuming alcohol; also, those with arrhythmia, coronary artery disease, and heart failure. Overall, there was a pattern of exercise being associated with lower MCI risk among those without vascular factors. CONCLUSIONS Spending more time engaging in exercise each week may offer protection against MCI in late life, with some variation among those with different vascular conditions and risk factors. Our findings may help target subgroups for exercise recommendations and interventions, and also generate hypotheses to test regarding underlying mechanisms.
Collapse
Affiliation(s)
- Tiffany F. Hughes
- Youngstown State University, Youngstown, OH, United States of America
| | - Anran Liu
- University of Pittsburgh, Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA, United States of America
| | - Erin Jacobsen
- University of Pittsburgh, School of Medicine, Department of Psychiatry, Pittsburgh, PA, United States of America
| | - Caterina Rosano
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA, United State of America
| | - Sarah B. Berman
- University of Pittsburgh, School of Medicine, Department of Neurology, Pittsburgh, PA, United States of America
| | - Chung-Chou H. Chang
- University of Pittsburgh, Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA, United States of America
- University of Pittsburgh, School of Medicine, Department of Medicine, Pittsburgh, PA, United States of America
| | - Mary Ganguli
- University of Pittsburgh, School of Medicine, Department of Psychiatry, Pittsburgh, PA, United States of America
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA, United State of America
- University of Pittsburgh, School of Medicine, Department of Neurology, Pittsburgh, PA, United States of America
| |
Collapse
|
9
|
Abstract
Background Social isolation and loneliness have detrimental effects on the health of older adults. Being socially isolated and lonely are likely both predictors and consequences of cognitive impairment with aging. However, isolation and loneliness may be differentially associated with cognitive impairment and may operate through both shared and unique pathways. The present study aimed to examine the association of social isolation and loneliness with concurrent cognitive impairment, and to explore potential mechanisms of the association. Methods Participants (n =1,982; Mage = 77.65 years, 1,210 (61.1%) female, 1,877 (94.7%) white, 815 (41.12% > high school education) were from a population‐based study of mild cognitive impairment and dementia. Three composite measures derived from factor analysis, representing social network structure, social connectedness, and loneliness were examined in relation to clinical dementia rating (CDR normal = 0 vs. CDR impaired >= 0.5) at baseline, adjusted for demographic characteristics. The indirect effects of the composite measures were also estimated conditioned on general health and function, lifestyle factors, vascular health, depressive symptoms, and sleep. Results Of the participants, 569 (28.71%) were cognitively impaired at baseline. Social connectedness (OR 1.48, 95% CI=1.33‐1.64) and loneliness (OR 1.38, 95% CI=1.24‐1.54), but not social network structure, were significantly associated with greater likelihood of being cognitively impaired after adjustment for demographics. These effects remained significant after separate adjustments for general health and function, lifestyle factors, vascular health, depressive symptoms, sleep, and other composites. The effect of social connectedness was appreciably attenuated by general health status and function (OR 1.37, 95% CI=1.22‐1.54), while loneliness was appreciably attenuated by depressive symptoms (OR 1.26, 95% CI=1.12‐1.42). Conclusions Older adults with lower levels of social connectedness and higher perception of loneliness are more likely to be cognitively impaired, which were partially explained by health and function and depressive symptoms, respectively. Addressing these factors may reduce risk for cognitive impairment, or conversely, reduce risk for disconnectedness and loneliness among those with cognitive impairment. These results have implications for the impact that limited social contact and feelings of loneliness during the COVID‐19 pandemic may have on older adults with or at risk for cognitive impairment.
Collapse
Affiliation(s)
| | - Fang Fang
- University of Pittsburgh Pittsburgh PA USA
| | | | | | | |
Collapse
|
10
|
Makkar SR, Lipnicki DM, Crawford JD, Kochan NA, Castro-Costa E, Lima-Costa MF, Diniz BS, Brayne C, Stephan B, Matthews F, Llibre-Rodriguez JJ, Llibre-Guerra JJ, Valhuerdi-Cepero AJ, Lipton RB, Katz MJ, Zammit A, Ritchie K, Carles S, Carriere I, Scarmeas N, Yannakoulia M, Kosmidis M, Lam L, Fung A, Chan WC, Guaita A, Vaccaro R, Davin A, Kim KW, Han JW, Suh SW, Riedel-Heller SG, Roehr S, Pabst A, Ganguli M, Hughes TF, Jacobsen EP, Anstey KJ, Cherbuin N, Haan MN, Aiello AE, Dang K, Kumagai S, Narazaki K, Chen S, Ng TP, Gao Q, Nyunt MSZ, Meguro K, Yamaguchi S, Ishii H, Lobo A, Lobo Escolar E, De la Cámara C, Brodaty H, Trollor JN, Leung Y, Lo JW, Sachdev P. Education and the moderating roles of age, sex, ethnicity and apolipoprotein epsilon 4 on the risk of cognitive impairment. Arch Gerontol Geriatr 2020; 91:104112. [PMID: 32738518 PMCID: PMC7724926 DOI: 10.1016/j.archger.2020.104112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 05/01/2020] [Accepted: 05/12/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND We examined how the relationship between education and latelife cognitive impairment (defined as a Mini Mental State Examination score below 24) is influenced by age, sex, ethnicity, and Apolipoprotein E epsilon 4 (APOE*4). METHODS Participants were 30,785 dementia-free individuals aged 55-103 years, from 18 longitudinal cohort studies, with an average follow-up ranging between 2 and 10 years. Pooled hazard ratios were obtained from multilevel parametric survival analyses predicting cognitive impairment (CI) from education and its interactions with baseline age, sex, APOE*4 and ethnicity. In separate models, education was treated as continuous (years) and categorical, with participants assigned to one of four education completion levels: Incomplete Elementary; Elementary; Middle; and High School. RESULTS Compared to Elementary, Middle (HR = 0.645, P = 0.004) and High School (HR = 0.472, P < 0.001) education were related to reduced CI risk. The decreased risk of CI associated with Middle education weakened with older baseline age (HR = 1.029, P = 0.056) and was stronger in women than men (HR = 1.309, P = 0.001). The association between High School and lowered CI risk, however, was not moderated by sex or baseline age, but was stronger in Asians than Whites (HR = 1.047, P = 0.044), and significant among Asian (HR = 0.34, P < 0.001) and Black (HR = 0.382, P = 0.016), but not White, APOE*4 carriers. CONCLUSION High School completion may reduce risk of CI associated with advancing age and APOE*4. The observed ethnoregional differences in this effect are potentially due to variations in social, economic, and political outcomes associated with educational attainment, in combination with neurobiological and genetic differences, and warrant further study.
Collapse
Affiliation(s)
- Steve R Makkar
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia.
| | - Darren M Lipnicki
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - John D Crawford
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | | | | | - Breno Satler Diniz
- Department of Psychiatry, Faculty of Medicine University, Toronto, Canada; Geriatric Psychiatry Division, Center for Addiction and Mental Health, Toronto, ON, Canada
| | - Carol Brayne
- Department of Public Health and Primary Care, Cambridge University, UK
| | - Blossom Stephan
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Matthews
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Jorge J Llibre-Guerra
- Institute of Neurology and Neurosurgery Havana, Cuba, Memory and Aging Center, UCSF San Francisco, United States
| | | | - Richard B Lipton
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, New York City, NY, United States; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Yeshiva University, New York City, NY, United States; Department of Psychiatry and Behavioral Medicine, Albert Einstein College of Medicine, Yeshiva University, New York City, NY, United States
| | - Mindy J Katz
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, New York City, NY, United States
| | - Andrea Zammit
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, New York City, NY, United States
| | - Karen Ritchie
- Inserm, U1061 Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, Montpellier Cedex 5, France; Université de Montpellier, Montpellier, France; Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Sophie Carles
- Inserm, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Paris, F-75014 France; Paris Descartes University, Paris, France; Univ Paris-Sud, Villejuif, France
| | - Isabelle Carriere
- Inserm, U1061 Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, Montpellier Cedex 5, France; Université de Montpellier, Montpellier, France
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece; Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Gertrude H Sergievsky Center, Department of Neurology, Columbia University, New York, NY, United States
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics (M.Y.), Harokopio University, Athens, Greece
| | - Mary Kosmidis
- Laboratory of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Linda Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong
| | - Ada Fung
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Wai Chi Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - Antonio Guaita
- Golgi Cenci Foundation, Corso San Martino 10, 20081 Abbiategrasso, Italy
| | - Roberta Vaccaro
- Golgi Cenci Foundation, Corso San Martino 10, 20081 Abbiategrasso, Italy
| | - Annalisa Davin
- Golgi Cenci Foundation, Corso San Martino 10, 20081 Abbiategrasso, Italy
| | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Psychiatry, Seoul National University, College of Medicine, Seoul, South Korea; Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, South Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seung Wan Suh
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Susanne Roehr
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Mary Ganguli
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Tiffany F Hughes
- Department of Sociology, Anthropology, and Gerontology, Youngstown State University, Youngstown, OH, United States
| | - Erin P Jacobsen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Kaarin J Anstey
- School of Psychology, University of New South Wales, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia; Centre for Research on Ageing, Health and Wellbeing, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Nicolas Cherbuin
- Centre for Research on Ageing, Health and Wellbeing, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Mary N Haan
- University of California, School of Medicine, Department of Epidemiology and Biostatistics, CA, United States
| | - Allison E Aiello
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Carolina Population Center, Chapel Hill, NC, United States
| | - Kristina Dang
- University of California, School of Medicine, Department of Epidemiology and Biostatistics, CA, United States
| | - Shuzo Kumagai
- Center for Health Science and Counseling, Kyushu University, 6-1 Kasuga kouen, Kasuga City, Fukuoka, 816-8580, Japan
| | - Kenji Narazaki
- Faculty of Socio-Environmental Studies, Department of Socio-Environmental Studies, Fukuoka Institute of Technology, 3-30-1 Wajiro-higashi, Higashi-ku, Fukuoka 811-0295, Japan
| | - Sanmei Chen
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjyuku-ku, Tokyo 162-8655, Japan
| | - Tze Pin Ng
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Qi Gao
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ma Shwe Zin Nyunt
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kenichi Meguro
- Geriatric Behavioral Neurology, Tohoku University, Japan
| | | | - Hiroshi Ishii
- Geriatric Behavioral Neurology, Tohoku University, Japan
| | - Antonio Lobo
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Universidad de Zaragoza, Zaragoza, Spain
| | - Elena Lobo Escolar
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Universidad de Zaragoza, Zaragoza, Spain
| | - Concepción De la Cámara
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Universidad de Zaragoza, Zaragoza, Spain
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia; Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia
| | - Julian N Trollor
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia; Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Australia
| | - Yvonne Leung
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Jessica W Lo
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia
| | - Perminder Sachdev
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia; Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia
| |
Collapse
|
11
|
Hughes TF, Beer JC, Jacobsen E, Ganguli M, Chang CCH, Rosano C. Executive function predicts decline in mobility after a fall: The MYHAT study. Exp Gerontol 2020; 137:110948. [PMID: 32302664 DOI: 10.1016/j.exger.2020.110948] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 03/09/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Evidence suggests that better cognitive functioning is associated with better mobility in older age. It is unknown whether older adults with better cognitive function are more resilient to mobility decline after a fall. METHODS Participants from the Monongahela Youghiogheny Healthy Aging Team (MYHAT) study were followed annually for up to 9 years for incident falls. We examined one-year (mean 1.0 year, SD 0.1) change in mobility pre- to post-fall using the Timed Up and Go (TUG) in relation to pre-fall cognition (executive function, attention, memory, and visuospatial function) among incident fallers (n = 598, mean age 79.1, SD = 7.0). Linear regression models tested the association of cognition with change in TUG. Interaction terms were tested to explore if age, sex, body mass index, physical activity, depressive symptoms, or visual acuity modified the associations of cognition and mobility among fallers. The association between cognition and one-year change in TUG was also tested in a comparison sample of non-fallers (n = 442, mean age 76.3, SD = 7.2). RESULTS Overall, mobility decline was greater in fallers compared to non-fallers. In fully-adjusted models, higher executive function, but not attention, memory, or visuospatial function, was associated with less decline in mobility among incident fallers. The effect was significantly stronger for those who were older, sedentary, and had lower body mass index. Higher scores in memory tests, but not in other domains, was associated with less mobility decline among non-fallers. CONCLUSIONS Higher executive function may offer resilience to mobility decline after a fall, especially among older adults with other risk factors for mobility decline. Future studies should assess whether executive function may be a helpful risk index of fall-related physical functional decline in geriatric settings.
Collapse
Affiliation(s)
- Tiffany F Hughes
- Department of Sociology, Anthropology, and Gerontology, Youngstown State University, United States of America
| | - Joanne C Beer
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, United States of America
| | - Erin Jacobsen
- Department of Psychiatry, University of Pittsburgh, United States of America
| | - Mary Ganguli
- Department of Psychiatry, University of Pittsburgh, United States of America
| | - Chung-Chou H Chang
- Department of Biostatistics, University of Pittsburgh, United States of America
| | - Caterina Rosano
- Department of Epidemiology, University of Pittsburgh, United States of America.
| |
Collapse
|
12
|
Hughes TF, Carramusa C, Van Dussen DJ. ASSOCIATION BETWEEN COGNITION AND FALL RISK BASED ON THE STEADI ALGORITHM: PROJECT VIBE. Innov Aging 2019. [PMCID: PMC6840634 DOI: 10.1093/geroni/igz038.1068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Falls are a growing concern among older adults with estimates that one in four fall each year. Older adults who experience a fall are at higher risk for poor health outcomes that threaten independence and increase risk of death. Impairment in cognitive function is known to be associated with greater fall occurrence; however, cognitive testing is not an integral part of clinical fall risk assessment. The purpose of this study is to examine cognitive performance in relation to fall risk level and its components determined using the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) algorithm. One hundred eight community dwelling older adults (mean age 79(SD 7.3) years, 76% women, and 56% college or higher education) were included. Cognition was assessed with the Montreal Cognitive Assessment (MoCA; >= 26 normal). The STEADI algorithm was used to assess fall risk (low vs. moderate/high) based on the Stay Independent screening (>= 4), impairment in gait (Timed Up and Go (TUG)), strength (30-second chair stand), and balance (4-stage balance), and number of falls (>= 2). Associations between cognition and fall risk and its components were assessed using logistic regression adjusting for age, gender, and education. Normal cognitive status was marginally associated with lower likelihood of moderate/high compared to low fall risk (OR 0.42, 95% CI 0.17-1.04), and with a lower likelihood of TUG impairment (OR 0.22, 95% CI 0.07-0.66). These results suggest cognitive status may contribute important information about older adults’ fall risk and should be considered an integral part of fall risk assessment.
Collapse
Affiliation(s)
| | - Cara Carramusa
- Youngstown State University, Youngstown, Ohio, United States
| | | |
Collapse
|
13
|
Liu A, Sun Z, McDade EM, Hughes TF, Ganguli M, Chang CCH. Blood Pressure and Memory: Novel Approaches to Modeling Nonlinear Effects in Longitudinal Studies. Alzheimer Dis Assoc Disord 2019; 33:291-298. [PMID: 31567145 PMCID: PMC6878165 DOI: 10.1097/wad.0000000000000346] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Linear models cannot capture nonlinear associations when the relationships between cognition and risk factors vary across risk levels. We demonstrate a method of modelling nonlinear associations using the example of blood pressure (BP) and memory. METHODS We measured memory and BP (in mm Hg) annually for 10 years in a population-based cohort (N=1982) aged 65+. We evaluated the relationship between BP and memory at the same time points using both linear mixed models and generalized additive mixed models with smoothing splines, adjusting for relevant covariates. RESULTS Linear mixed models found no significant associations. Generalized additive mixed models detected different associations between BP and memory across baseline BP categories (normotensive, hypertensive, hypotensive). Among normotensives, systolic blood pressure (SBP)/diastolic blood pressure (DBP) around 140/80 was associated with the highest, while SBP/DBP around 110/60 was associated with the lowest, predicted memory scores. Among hypertensives, SBP/DBP around 130/85 was associated with the highest, while SBP/DBP around 150/65 was associated with the lowest, predicted memory scores. Among hypotensives, no significant association was found. Among both normotensives and hypertensives, a DBP >75 was associated with better memory. CONCLUSIONS By modelling nonlinear associations, we showed that the relationship between BP and memory performance varied by baseline BP among normotensives and hypertensives.
Collapse
Affiliation(s)
| | | | - Eric M McDade
- Department of Neurology, Washington University in St. Louis, St. Louis, MO
| | - Tiffany F Hughes
- Department of Anthropology, Sociology, and Gerontology, Youngstown State University, Youngstown, OH
| | | | - Chung-Chou H Chang
- Departments of Biostatistics
- Medicine, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
14
|
Sullivan KJ, Dodge HH, Hughes TF, Chang CCH, Zhu X, Liu A, Ganguli M. Declining Incident Dementia Rates Across Four Population-Based Birth Cohorts. J Gerontol A Biol Sci Med Sci 2019; 74:1439-1445. [PMID: 30312371 PMCID: PMC6696712 DOI: 10.1093/gerona/gly236] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Incidence rates of dementia appear to be declining in high-income countries according to several large epidemiological studies. We aimed to describe declining incident dementia rates across successive birth cohorts in a U.S. population-based sample and to explore the influences of sex and education on these trends. METHODS We pooled data from two community-sampled prospective cohort studies with similar study aims and contiguous sampling regions: the Monongahela Valley Independent Elders Survey (1987-2001) and the Monongahela-Youghiogheny Healthy Aging Team (2006-Ongoing). We identified four decade-long birth cohorts spanning birth years 1902-1941. In an analysis sample of 3,010 participants (61% women, mean baseline age = 75.7 years, mean follow-up = 7.1 years), we identified 257 cases of incident dementia indicated by a Clinical Dementia Rating of 1.0 or higher. We used Poisson regression to model incident dementia rates by birth cohort, age, sex, education, and interactions of Sex × Cohort and Sex × Education. We further examined whether cohort effects varied by education, testing a Cohort × Education interaction and stratifying the models by education. RESULTS Compared to the earliest birth cohort (1902-1911), each subsequent cohort had a significantly lower incident dementia rate (1912-1921: incidence rate ratio [IRR] = 0.655, 95% confidence interval [95% CI] = 0.477-0.899; 1922-1931: IRR = 0.387, 95% CI = 0.265-0.564; 1932-1941: IRR = 0.233, 95% CI = 0.121-0.449). We observed no significant interactions of either sex or education with birth cohort. CONCLUSIONS A decline in incident dementia rates was observed across successive birth cohorts independent of sex, education, and age.
Collapse
Affiliation(s)
| | - Hiroko H Dodge
- Michigan Alzheimer’s Disease Center, Department of Neurology, University of Michigan, Ann Arbor
- Layton Aging and Alzheimer’s Disease Center, Department of Neurology, Oregon Health & Science University, Portland
| | - Tiffany F Hughes
- Department of Sociology, Anthropology, and Gerontology, Youngstown State University, Ohio
| | - Chung-Chou H Chang
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
- Department of Medicine, University of Pittsburgh, Pennsylvania
| | - Xinmei Zhu
- Department of Medicine, University of Pittsburgh, Pennsylvania
| | - Anran Liu
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Mary Ganguli
- Department of Epidemiology, University of Michigan, Ann Arbor
- Department of Medicine, University of Pittsburgh, Pennsylvania
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pennsylvania
| |
Collapse
|
15
|
Lipnicki DM, Makkar SR, Crawford JD, Thalamuthu A, Kochan NA, Lima-Costa MF, Castro-Costa E, Ferri CP, Brayne C, Stephan B, Llibre-Rodriguez JJ, Llibre-Guerra JJ, Valhuerdi-Cepero AJ, Lipton RB, Katz MJ, Derby CA, Ritchie K, Ancelin ML, Carrière I, Scarmeas N, Yannakoulia M, Hadjigeorgiou GM, Lam L, Chan WC, Fung A, Guaita A, Vaccaro R, Davin A, Kim KW, Han JW, Suh SW, Riedel-Heller SG, Roehr S, Pabst A, van Boxtel M, Köhler S, Deckers K, Ganguli M, Jacobsen EP, Hughes TF, Anstey KJ, Cherbuin N, Haan MN, Aiello AE, Dang K, Kumagai S, Chen T, Narazaki K, Ng TP, Gao Q, Nyunt MSZ, Scazufca M, Brodaty H, Numbers K, Trollor JN, Meguro K, Yamaguchi S, Ishii H, Lobo A, Lopez-Anton R, Santabárbara J, Leung Y, Lo JW, Popovic G, Sachdev PS. Determinants of cognitive performance and decline in 20 diverse ethno-regional groups: A COSMIC collaboration cohort study. PLoS Med 2019; 16:e1002853. [PMID: 31335910 PMCID: PMC6650056 DOI: 10.1371/journal.pmed.1002853] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/14/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND With no effective treatments for cognitive decline or dementia, improving the evidence base for modifiable risk factors is a research priority. This study investigated associations between risk factors and late-life cognitive decline on a global scale, including comparisons between ethno-regional groups. METHODS AND FINDINGS We harmonized longitudinal data from 20 population-based cohorts from 15 countries over 5 continents, including 48,522 individuals (58.4% women) aged 54-105 (mean = 72.7) years and without dementia at baseline. Studies had 2-15 years of follow-up. The risk factors investigated were age, sex, education, alcohol consumption, anxiety, apolipoprotein E ε4 allele (APOE*4) status, atrial fibrillation, blood pressure and pulse pressure, body mass index, cardiovascular disease, depression, diabetes, self-rated health, high cholesterol, hypertension, peripheral vascular disease, physical activity, smoking, and history of stroke. Associations with risk factors were determined for a global cognitive composite outcome (memory, language, processing speed, and executive functioning tests) and Mini-Mental State Examination score. Individual participant data meta-analyses of multivariable linear mixed model results pooled across cohorts revealed that for at least 1 cognitive outcome, age (B = -0.1, SE = 0.01), APOE*4 carriage (B = -0.31, SE = 0.11), depression (B = -0.11, SE = 0.06), diabetes (B = -0.23, SE = 0.10), current smoking (B = -0.20, SE = 0.08), and history of stroke (B = -0.22, SE = 0.09) were independently associated with poorer cognitive performance (p < 0.05 for all), and higher levels of education (B = 0.12, SE = 0.02) and vigorous physical activity (B = 0.17, SE = 0.06) were associated with better performance (p < 0.01 for both). Age (B = -0.07, SE = 0.01), APOE*4 carriage (B = -0.41, SE = 0.18), and diabetes (B = -0.18, SE = 0.10) were independently associated with faster cognitive decline (p < 0.05 for all). Different effects between Asian people and white people included stronger associations for Asian people between ever smoking and poorer cognition (group by risk factor interaction: B = -0.24, SE = 0.12), and between diabetes and cognitive decline (B = -0.66, SE = 0.27; p < 0.05 for both). Limitations of our study include a loss or distortion of risk factor data with harmonization, and not investigating factors at midlife. CONCLUSIONS These results suggest that education, smoking, physical activity, diabetes, and stroke are all modifiable factors associated with cognitive decline. If these factors are determined to be causal, controlling them could minimize worldwide levels of cognitive decline. However, any global prevention strategy may need to consider ethno-regional differences.
Collapse
Affiliation(s)
- Darren M. Lipnicki
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
| | - Steve R. Makkar
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
| | - John D. Crawford
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
| | - Anbupalam Thalamuthu
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
| | - Nicole A. Kochan
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | - Carol Brayne
- Department of Public Health and Primary Care, Cambridge University, Cambridge, United Kingdom
| | - Blossom Stephan
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Jorge J. Llibre-Guerra
- Institute of Neurology and Neurosurgery, Havana, Cuba
- Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States of America
| | | | - Richard B. Lipton
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, New York, New York, United States of America
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Yeshiva University, New York, New York, United States of America
- Department of Psychiatry and Behavioral Medicine, Albert Einstein College of Medicine, Yeshiva University, New York, New York, United States of America
| | - Mindy J. Katz
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, New York, New York, United States of America
| | - Carol A. Derby
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, New York, New York, United States of America
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Yeshiva University, New York, New York, United States of America
| | - Karen Ritchie
- Inserm, U1061 Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, Montpellier, France
- Université de Montpellier, Montpellier, France
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Marie-Laure Ancelin
- Inserm, U1061 Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, Montpellier, France
- Université de Montpellier, Montpellier, France
| | - Isabelle Carrière
- Inserm, U1061 Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, Montpellier, France
- Université de Montpellier, Montpellier, France
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, New York, New York, United States of America
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Georgios M. Hadjigeorgiou
- University of Thessaly, Larissa, Greece
- Department of Neurology, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Linda Lam
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wai-chi Chan
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
| | - Ada Fung
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China
| | | | | | | | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Psychiatry, College of Medicine, Seoul National University, Seoul, Korea
- Department of Brain and Cognitive Science, College of Natural Sciences, Seoul National University, Seoul, Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung Wan Suh
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Susanne Roehr
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Martin van Boxtel
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Kay Deckers
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mary Ganguli
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Erin P. Jacobsen
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Tiffany F. Hughes
- Department of Sociology, Anthropology, and Gerontology, Youngstown State University, Youngstown, Ohio, United States of America
| | - Kaarin J. Anstey
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Nicolas Cherbuin
- Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Mary N. Haan
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Allison E. Aiello
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Kristina Dang
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Shuzo Kumagai
- Center for Health Science and Counseling, Kyushu University, Kasuga, Japan
| | - Tao Chen
- Center for Health Science and Counseling, Kyushu University, Kasuga, Japan
| | - Kenji Narazaki
- Faculty of Socio-Environmental Studies, Fukuoka Institute of Technology, Fukuoka, Japan
| | - Tze Pin Ng
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Qi Gao
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ma Shwe Zin Nyunt
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Marcia Scazufca
- Instituto de Psiquiatria e LIM-23, Hospital da Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
- Dementia Collaborative Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Katya Numbers
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
| | - Julian N. Trollor
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Kenichi Meguro
- Geriatric Behavioral Neurology, Tohoku University, Sendai, Japan
| | | | - Hiroshi Ishii
- Geriatric Behavioral Neurology, Tohoku University, Sendai, Japan
| | - Antonio Lobo
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Ministry of Science and Innovation, Madrid, Spain
| | - Raul Lopez-Anton
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Ministry of Science and Innovation, Madrid, Spain
- Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
| | - Javier Santabárbara
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Ministry of Science and Innovation, Madrid, Spain
- Department of Microbiology, Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain
| | - Yvonne Leung
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
| | - Jessica W. Lo
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
| | - Gordana Popovic
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
- School of Mathematics and Statistics, University of New South Wales, Sydney, New South Wales, Australia
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
- Dementia Collaborative Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | | |
Collapse
|
16
|
Ganguli M, Jia Y, Hughes TF, Snitz BE, Chang CCH, Berman SB, Sullivan KJ, Kamboh MI. Mild Cognitive Impairment that Does Not Progress to Dementia: A Population-Based Study. J Am Geriatr Soc 2018; 67:232-238. [PMID: 30444944 DOI: 10.1111/jgs.15642] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/08/2018] [Accepted: 09/13/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVE In population studies, most individuals with mild cognitive impairment (MCI) do not progress to dementia in the near term, but rather remain stable MCI or revert to normal cognition. Here, we characterized MCI subgroups with different outcomes over 5 years. SETTING/PARTICIPANTS A population-based cohort (N=1603). MEASUREMENTS Clinical Dementia Rating (CDR); self-reported medical conditions, subjective cognitive concerns, self-rated health, depressive symptoms, blood pressure, medications, blood pressure, APOE genotype, cognitive domain composite scores. DESIGN We compared 3 MCI subgroups who progressed to dementia (n=86), stabilized at MCI (n=384), or reverted to normal (n=252), to those who remained consistently normal (n=881), defining MCI as CDR = 0.5 and dementia as CDR≥1. Using multinomial logistic regression models adjusted for demographics, we examined the associations of each group with selected baseline characteristics. RESULTS With the normal group for reference, worse subjective cognitive concerns, functional impairments, self-rated health, and depressive symptoms were associated with being in any MCI group. Taking more prescription medications was associated with being in the stable MCI and reverter groups; diabetes and low diastolic blood pressure were associated with stable MCI. The APOE4 genotype was associated with stable and progressive MCI; stroke was associated with progressive MCI. All MCI subgroups were likely to have lower mean composite scores in all cognitive domains and more operationally defined impairments in attention, language, and executive function; reverters were more likely to lack memory and visuospatial impairments. CONCLUSIONS MCI subgroups with different 5-year outcomes had some distinct characteristics suggesting different underlying causes. The progressors, unlike the reverters, had a profile broadly typical of Alzheimer's disease; the stable MCIs had other, including vascular, morbidity. These data shed light on the heterogeneity of MCI in the population. J Am Geriatr Soc 67:232-238, 2019.
Collapse
Affiliation(s)
- Mary Ganguli
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yichen Jia
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tiffany F Hughes
- Department of Sociology, Anthropology, and Gerontology, Youngstown State University, Youngstown, Ohio
| | - Beth E Snitz
- Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Chung-Chou H Chang
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sarah B Berman
- Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kevin J Sullivan
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - M Ilyas Kamboh
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
17
|
Sullivan KJ, Dodge HH, Hughes TF, Chang CC, Ganguli M. P1‐623: DECLINING DEMENTIA INCIDENCE IN THE MONONGAHELA VALLEY: BIRTH COHORT ANALYSES FROM THE MOVIES AND MYHAT STUDIES. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | | | - Mary Ganguli
- University of Pittsburgh School of MedicinePittsburghPAUSA
| |
Collapse
|
18
|
Hughes TF, Liu A, Sun Z, Jacobsen EP, Chang CC, Ganguli M. P3‐595: CARDIOVASCULAR MODIFIERS OF THE ASSOCIATION BETWEEN EXERCISE AND RISK FOR MILD COGNITIVE IMPAIRMENT: THE MYHAT STUDY. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.1961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Anran Liu
- University of PittsburghPittsburghPAUSA
| | | | | | - Chung-Chou Chang
- University of PittsburghGraduate School of Public HealthPittsburghPAUSA
| | - Mary Ganguli
- University of PittsburghSchool of MedicinePittsburghPAUSA
| |
Collapse
|
19
|
Snitz BE, Wang T, Cloonan YK, Jacobsen E, Chang CCH, Hughes TF, Kamboh MI, Ganguli M. Risk of progression from subjective cognitive decline to mild cognitive impairment: The role of study setting. Alzheimers Dement 2018; 14:734-742. [PMID: 29352855 DOI: 10.1016/j.jalz.2017.12.003] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [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: 08/09/2017] [Revised: 11/29/2017] [Accepted: 12/07/2017] [Indexed: 01/05/2023]
Abstract
INTRODUCTION We compared risk of progression from subjective cognitive decline (SCD) to mild cognitive impairment (MCI) in an academic memory clinic versus a population-based study. METHODS Older adults presenting at a memory clinic were classified as SCD (n = 113) or as noncomplainers (n = 82). Participants from a population study were classified as SCD (n = 592) and noncomplainers (n = 589) based on a memory complaint score. Annual follow-up performed for a mean of 3 years. RESULTS The adjusted hazard ratio for SCD was 15.97 (95% confidence interval: 6.08-42.02, P < .001) in the memory clinic versus 1.18 (95% confidence interval: 1.00-1.40, P = .047) in the population study, where reported "worry" about memory further increased SCD-associated risk for MCI. DISCUSSION SCD is more likely to progress to MCI in a memory clinic than the general population; participants' characteristics vary across settings. Study setting should be considered when evaluating SCD as a risk state for MCI and dementia.
Collapse
Affiliation(s)
- Beth E Snitz
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Tianxiu Wang
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yona Keich Cloonan
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erin Jacobsen
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Tiffany F Hughes
- Department of Gerontology, Youngstown State University, Youngstown, OH, USA
| | - M Ilyas Kamboh
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary Ganguli
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
20
|
Dodge HH, Zhu J, Hughes TF, Snitz BE, Chang CCH, Ganguli M. O2‐05‐03: Birth Cohort Effects in Memory Function and Practice Effects From Epidemiological Studies of Cognitive Impairment and Dementia. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Hiroko H. Dodge
- Oregon Health & Science UniversityPortlandOR USA
- University of MichiganAnn ArborMI USA
- Oregon Center for Aging & Technology (ORCATECH)PortlandOR USA
| | - Jian Zhu
- University of Michigan School of Public HealthAnn ArborMI USA
| | | | | | | | - Mary Ganguli
- University of Pittsburgh Graduate School of Public HealthPittsburghPA USA
- University of Pittsburgh School of MedicinePittsburghPA USA
| |
Collapse
|
21
|
Flatt JD, Hughes TF, Documét PI, Lingler JH, Trauth JM, Albert SM. A Qualitative Study on the Types and Purposes of Social Activities in Late Life. Act Adapt Aging 2016; 39:109-132. [PMID: 26823639 DOI: 10.1080/01924788.2015.1024485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This qualitative study examines older adults' subjective views on the types and purposes of social activities. In-depth interviews were conducted with a purposive sample of 20 older adults, with low (n = 10) and high (n = 10) memory performance. We used grounded theory methods to analyze the narrative data. Four types of social activities-Altruism, Creativity, Game, and Motion-were identified. The purpose of social activities included enjoyment, relaxation, stimulation, and belongingness. Those in the low memory group seemed to face more barriers to participation. Different types of social activities may be important for cognitive health and well-being.
Collapse
Affiliation(s)
- Jason D Flatt
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Tiffany F Hughes
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Patricia I Documét
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Jennifer H Lingler
- Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA 15261, USA
| | - Jeanette M Trauth
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Steven M Albert
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
| |
Collapse
|
22
|
Hughes TF, Becker JT, Lee CW, Chang CCH, Ganguli M. Independent and combined effects of cognitive and physical activity on incident MCI. Alzheimers Dement 2015; 11:1377-84. [PMID: 25684687 PMCID: PMC4536189 DOI: 10.1016/j.jalz.2014.11.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 10/17/2014] [Accepted: 11/20/2014] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The objective of this study was to examine the independent and combined influences of late-life cognitive activity (CA) and physical activity (PA) on the risk of incident mild cognitive impairment (MCI). METHODS We used interval censored survival modeling to examine the risk of incident MCI (Clinical Dementia Rating [CDR] = 0.5) as a function of CA (high vs. low) and at least moderate intensity PA (any vs. none) among 864 cognitively normal (CDR = 0) older adults. RESULTS During three annual follow-up waves, 72 participants developed MCI. Compared with low CA with no PA, significant reductions in risk for MCI were observed for high CA with any PA (hazards ratio (HR) = 0.20, 95% confidence interval (CI) 0.07-0.52) and low CA with any PA (HR = 0.52, 95% CI 0.29-0.93), but not for high CA without PA (HR = 0.94, 95% CI 0.45-1.95). DISCUSSION These findings suggest that a combination of CA and PA may be most efficacious at reducing the risk for cognitive impairment.
Collapse
Affiliation(s)
- Tiffany F Hughes
- Department of Psychiatry, University of Pittsburgh, Pittsburgh PA, USA.
| | - James T Becker
- Department of Psychiatry, University of Pittsburgh, Pittsburgh PA, USA; Department of Neurology, University of Pittsburgh, Pittsburgh PA, USA; Department of Psychology, University of Pittsburgh, Pittsburgh PA, USA
| | - Ching-Wen Lee
- Department of Psychiatry, University of Pittsburgh, Pittsburgh PA, USA
| | - Chung-Chou H Chang
- Department of Medicine, University of Pittsburgh, Pittsburgh PA, USA; Department of Biostatistics, University of Pittsburgh, Pittsburgh PA, USA
| | - Mary Ganguli
- Department of Psychiatry, University of Pittsburgh, Pittsburgh PA, USA; Department of Neurology, University of Pittsburgh, Pittsburgh PA, USA; Department of Epidemiology, University of Pittsburgh, Pittsburgh PA, USA
| |
Collapse
|
23
|
Snitz BE, Small BJ, Wang T, Chang CCH, Hughes TF, Ganguli M. Do Subjective Memory Complaints Lead or Follow Objective Cognitive Change? A Five-Year Population Study of Temporal Influence. J Int Neuropsychol Soc 2015; 21:732-42. [PMID: 26477680 PMCID: PMC4615611 DOI: 10.1017/s1355617715000922] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The relationship between subjective memory complaints (SM) and objective memory (OM) performance in aging has been variably characterized in a substantial literature, to date. In particular, cross-sectional studies often observe weak or no associations. We investigated whether subjective memory complaints and objectively measured cognition influence each other over time, and if so, which is the stronger pathway of change-objective to subjective, or subjective to objective-or whether they are both important. Using bivariate latent change score modeling in data from a population study (N=1980) over 5 annual assessment cycles, we tested four corresponding hypotheses: (1) no coupling between SM and OM over time; (2) SM as leading indicator of change in OM; (3) OM as leading indicator of change in SM; (4) dual coupling over time, with both SM and OM leading subsequent change in the other. We also extended objective cognition to two other domains, language and executive functions. The dual-coupling models best fit the data for all three objective cognitive domains. The SM-OM temporal dynamics differ qualitatively compared to other domains, potentially reflecting changes in insight and self-awareness specific to memory impairment. Subjective memory and objective cognition reciprocally influence each other over time. The temporal dynamics between subjective and objective cognition in aging are nuanced, and must be carefully disentangled to shed light on the underlying processes.
Collapse
Affiliation(s)
- Beth E Snitz
- 1University of Pittsburgh,Pittsburgh,Pennsylvania
| | | | - Tianxiu Wang
- 1University of Pittsburgh,Pittsburgh,Pennsylvania
| | | | | | - Mary Ganguli
- 1University of Pittsburgh,Pittsburgh,Pennsylvania
| |
Collapse
|
24
|
Ganguli M, Lee CW, Snitz BE, Hughes TF, McDade E, Chang CCH. Rates and risk factors for progression to incident dementia vary by age in a population cohort. Neurology 2014; 84:72-80. [PMID: 25471390 PMCID: PMC4336092 DOI: 10.1212/wnl.0000000000001113] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To estimate rate of progression from normal cognition or mild impairment to dementia, and to identify potential risk and protective factors for incident dementia, based on age at dementia onset in a prospective study of a population-based cohort (n = 1,982) aged 65 years and older. METHODS Following the cohort annually for up to 5 years, we estimated incidence of dementia (Clinical Dementia Rating ≥1) among individuals previously normal or mildly impaired (Clinical Dementia Rating 0 or 0.5). In the whole cohort, and also stratified by median onset age, we examined several vascular, metabolic, and inflammatory variables as potential risk factors for developing dementia, using interval-censored survival models. RESULTS Based on 67 incident cases of dementia, incidence rate (per 1,000 person-years) was 10.0 overall, 5.8 in those with median onset age of 87 years or younger, and 31.5 in those with onset age after 87 years. Adjusting for demographics, the risk of incident dementia with onset age of 87 years or younger (n = 33) was significantly increased by baseline smoking, stroke, low systolic blood pressure, and APOE*4 genotype, and reduced by current alcohol use. Among those with dementia with onset after 87 years (n = 34), no risk or protective factor was significant. CONCLUSION Risk and protective factors were only found for incident dementia with onset before the median onset age of 87 years, and not for those with later onset. Either unexplored risk factors explain the continued increase in incidence with age, or unknown protective factors are allowing some individuals to delay onset into very old age.
Collapse
Affiliation(s)
- Mary Ganguli
- From the Departments of Psychiatry (M.G., C.-W.L., T.F.H.), Neurology (M.G., B.E.S., E.M.), and Medicine (C.-C.H.C.), School of Medicine, and Departments of Epidemiology (M.G.) and Biostatistics (C.-C.H.C.), Graduate School of Public Health, University of Pittsburgh, PA.
| | - Ching-Wen Lee
- From the Departments of Psychiatry (M.G., C.-W.L., T.F.H.), Neurology (M.G., B.E.S., E.M.), and Medicine (C.-C.H.C.), School of Medicine, and Departments of Epidemiology (M.G.) and Biostatistics (C.-C.H.C.), Graduate School of Public Health, University of Pittsburgh, PA
| | - Beth E Snitz
- From the Departments of Psychiatry (M.G., C.-W.L., T.F.H.), Neurology (M.G., B.E.S., E.M.), and Medicine (C.-C.H.C.), School of Medicine, and Departments of Epidemiology (M.G.) and Biostatistics (C.-C.H.C.), Graduate School of Public Health, University of Pittsburgh, PA
| | - Tiffany F Hughes
- From the Departments of Psychiatry (M.G., C.-W.L., T.F.H.), Neurology (M.G., B.E.S., E.M.), and Medicine (C.-C.H.C.), School of Medicine, and Departments of Epidemiology (M.G.) and Biostatistics (C.-C.H.C.), Graduate School of Public Health, University of Pittsburgh, PA
| | - Eric McDade
- From the Departments of Psychiatry (M.G., C.-W.L., T.F.H.), Neurology (M.G., B.E.S., E.M.), and Medicine (C.-C.H.C.), School of Medicine, and Departments of Epidemiology (M.G.) and Biostatistics (C.-C.H.C.), Graduate School of Public Health, University of Pittsburgh, PA
| | - Chung-Chou H Chang
- From the Departments of Psychiatry (M.G., C.-W.L., T.F.H.), Neurology (M.G., B.E.S., E.M.), and Medicine (C.-C.H.C.), School of Medicine, and Departments of Epidemiology (M.G.) and Biostatistics (C.-C.H.C.), Graduate School of Public Health, University of Pittsburgh, PA
| |
Collapse
|
25
|
Hughes TF, Flatt JD, Fu B, Butters MA, Chang CCH, Ganguli M. Interactive video gaming compared with health education in older adults with mild cognitive impairment: a feasibility study. Int J Geriatr Psychiatry 2014; 29:890-8. [PMID: 24452845 PMCID: PMC4326259 DOI: 10.1002/gps.4075] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [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: 07/29/2013] [Accepted: 12/17/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We evaluated the feasibility of a trial of Wii interactive video gaming, and its potential efficacy at improving cognitive functioning compared with health education, in a community sample of older adults with neuropsychologically defined mild cognitive impairment. METHODS Twenty older adults were equally randomized to either group-based interactive video gaming or health education for 90 min each week for 24 weeks. Although the primary outcomes were related to study feasibility, we also explored the effect of the intervention on neuropsychological performance and other secondary outcomes. RESULTS All 20 participants completed the intervention, and 18 attended at least 80% of the sessions. The majority (80%) of participants were "very much" satisfied with the intervention. Bowling was enjoyed by the most participants and was also rated the highest among the games for mental, social, and physical stimulation. We observed medium effect sizes for cognitive and physical functioning in favor of the interactive video gaming condition, but these effects were not statistically significant in this small sample. CONCLUSION Interactive video gaming is feasible for older adults with mild cognitive impairment, and medium effect sizes in favor of the Wii group warrant a larger efficacy trial.
Collapse
Affiliation(s)
- Tiffany F Hughes
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | | | | | | | | |
Collapse
|
26
|
Andreescu C, Teverovsky E, Fu B, Hughes TF, Chang CCH, Ganguli M. Old worries and new anxieties: behavioral symptoms and mild cognitive impairment in a population study. Am J Geriatr Psychiatry 2014; 22:274-84. [PMID: 23759435 PMCID: PMC3783616 DOI: 10.1016/j.jagp.2012.09.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [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: 04/17/2012] [Revised: 09/07/2012] [Accepted: 09/26/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To disentangle the complex associations of depression and anxiety with mild cognitive impairment (MCI) at the population level. We examined subgroups of anxiety symptoms and depression symptom profiles in relation to MCI, which we defined using both cognitive and functional approaches. METHODS We used an epidemiologic, cross-sectional study with an age-stratified, random, population-based sample of 1,982 individuals aged 65 years and over. Three definitions of MCI were used: 1) a purely cognitive classification into amnestic and nonamnestic MCI, 2) a combined cognitive-functional definition by International Working Group (IWG) criteria, and 3) a purely functional definition by the Clinical Dementia Rating (CDR) of 0.5. Three depression profiles were identified by factor analysis of the modified Center for Epidemiological Studies-Depression Scale: core mood, self-esteem/interpersonal, and apathy/neurovegetative profiles. Three anxiety groups, chronic mild worry, chronic severe anxiety, and recent-onset anxiety, were based on screening questions. RESULTS Recent-onset anxiety was associated with MCI by nonamnestic and IWG criteria, chronic severe anxiety was associated with MCI by all definitions, and chronic mild worry was associated with none. Of the depression profiles, the core mood profile was associated with CDR-defined MCI, the apathy/neurovegetative profile was associated with MCI by amnestic, IWG, and CDR definitions, and the self-esteem/interpersonal profile was associated with none. CONCLUSION In this population-based sample, subgroups with different anxiety and depression profiles had different relationships with cognitive and functional definitions of MCI. Anxiety, depression, and MCI are all multidimensional entities, interacting in complex ways that may shed light on underlying neural mechanisms.
Collapse
Affiliation(s)
- Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Esther Teverovsky
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Bo Fu
- Department of Psychiatry, University of Pittsburgh School of Medicine,Department of Biostatistics, University of Pittsburgh Graduate School of Public Health
| | - Tiffany F. Hughes
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Chung-Chou H. Chang
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health,Department of Medicine, University of Pittsburgh School of Medicine
| | - Mary Ganguli
- Department of Psychiatry, University of Pittsburgh School of Medicine,Department of Neurology, University of Pittsburgh School of Medicine,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health
| |
Collapse
|
27
|
Ganguli M, Fu B, Snitz BE, Hughes TF, Chang CCH. Mild cognitive impairment: incidence and vascular risk factors in a population-based cohort. Neurology 2013; 80:2112-20. [PMID: 23658380 DOI: 10.1212/wnl.0b013e318295d776] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE We examined the incidence of mild cognitive impairment (MCI) and its potential vascular risk factors in a prospective population-based study. METHODS An age-stratified random population-based cohort (baseline n = 1,982), followed for up to 4 years, was annually assessed for cognitive and everyday functioning. Incidence rates were calculated for both cognitive (neuropsychological [NP]-MCI) and functional (Clinical Dementia Rating [CDR] = 0.5) definitions of MCI. Several measures of vascular, metabolic, and inflammatory risk were assessed at baseline. Risk factor analyses used interval censoring survival models, followed by joint modeling of both MCI and attrition due to mortality and illness. RESULTS Incidence rates for NP-MCI and CDR = 0.5 were 95 and 55 per 1,000 person-years. In individual joint models, risk factors for NP-MCI were diabetes and adiposity (waist: hip ratio), while APOE ε4 genotype and heart failure increased risk of attrition. Adiposity, stroke, heart failure, and diabetes were risk factors for nonamnestic MCI. For CDR = 0.5, risk factors were stroke and heart failure; heart failure and adiposity increased risk of attrition. In multivariable joint models combining all risk factors, adiposity increased risk of NP-MCI, while stroke and heart failure increased risk for CDR = 0.5. Current alcohol use appeared protective against all subtypes. CONCLUSION Incidence of MCI increased with age regardless of definition and did not vary by sex or education. Several vascular risk factors elevated the risk of incident MCI, whether defined cognitively or functionally, but most were associated with nonamnestic MCI and CDR = 0.5. Controlling vascular risk may potentially reduce risk of MCI.
Collapse
Affiliation(s)
- Mary Ganguli
- Department of School of Medicine, Graduate School of Public Health, University of Pittsburgh, PA, USA.
| | | | | | | | | |
Collapse
|
28
|
Ganguli M, Snitz BE, Saxton JA, Chang CCH, Lee CW, Vander Bilt J, Hughes TF, Loewenstein DA, Unverzagt FW, Petersen RC. Outcomes of mild cognitive impairment by definition: a population study. ACTA ACUST UNITED AC 2011; 68:761-7. [PMID: 21670400 DOI: 10.1001/archneurol.2011.101] [Citation(s) in RCA: 231] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) has been defined in several ways. OBJECTIVE To determine the 1-year outcomes of MCI by different definitions at the population level. DESIGN Inception cohort with 1-year follow-up. Participants were classified as having MCI using the following definitions operationalized for this study: amnestic MCI by Mayo criteria, expanded MCI by International Working Group criteria, Clinical Dementia Rating (CDR) = 0.5, and a purely cognitive classification into amnestic and nonamnestic MCI. SETTING General community. PARTICIPANTS Stratified random population-based sample of 1982 individuals 65 years and older. MAIN OUTCOME MEASURES For each MCI definition, there were 3 possible outcomes: worsening (progression to dementia [CDR ≥ 1] or severe cognitive impairment), improvement (reversion to CDR = 0 or normal cognition), and stability (unchanged CDR or cognitive status). RESULTS Regardless of MCI definition, over 1 year, a small proportion of participants progressed to CDR > 1 (range, 0%-3%) or severe cognitive impairment (0%-20%) at rates higher than their cognitively normal peers. Somewhat larger proportions of participants improved or reverted to normal (6%-53%). Most participants remained stable (29%-92%). Where definitions focused on memory impairment and on multiple cognitive domains, higher proportions progressed and lower proportions reverted on the CDR. CONCLUSIONS As ascertained by several operational definitions, MCI is a heterogeneous entity at the population level but progresses to dementia at rates higher than in normal elderly individuals. Proportions of participants progressing to dementia are lower and proportions reverting to normal are higher than in clinical populations. Memory impairments and impairments in multiple domains lead to greater progression and lesser improvement. Research criteria may benefit from validation at the community level before incorporation into clinical practice.
Collapse
Affiliation(s)
- Mary Ganguli
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Small BJ, Rawson KS, Walsh E, Jim HSL, Hughes TF, Iser L, Andrykowski MA, Jacobsen PB. Catechol-O-methyltransferase genotype modulates cancer treatment-related cognitive deficits in breast cancer survivors. Cancer 2010; 117:1369-76. [DOI: 10.1002/cncr.25685] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 08/11/2010] [Accepted: 08/30/2010] [Indexed: 12/11/2022]
|
30
|
Hughes TF, Chang CCH, Vander Bilt J, Ganguli M. Engagement in reading and hobbies and risk of incident dementia: the MoVIES project. Am J Alzheimers Dis Other Demen 2010; 25:432-8. [PMID: 20660517 DOI: 10.1177/1533317510368399] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine whether there is an association between engagement in reading and hobbies and dementia risk in late life. METHODS A total of 942 members of a population-based, prospective cohort study were followed biennially to identify incident dementia cases. Cox proportional hazards models were used to estimate the risk of dementia in relation to baseline total number of activities and time commitment to reading and hobbies. RESULTS A lower risk for dementia was found for a greater number of activities and for a high (about 1 hour each day) compared with low (less than 30 minutes each day) weekly time commitment to hobbies, independent of covariates. Only the protective effect of hobbies remained after methods were used to minimize bias due to potential preclinical dementia. CONCLUSION Engaging in hobbies for 1 or more hours every day might be protective against dementia in late life.
Collapse
Affiliation(s)
- Tiffany F Hughes
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
| | | | | | | |
Collapse
|
31
|
Abstract
There is both popular and scientific interest in keeping the brain young and avoiding cognitive impairment and dementia. Older adults may be able to modify their cognitive health status through certain health behaviors. The aim of this review is to highlight the potential impact that cognitive activity may have on cognitive health outcomes in late life. Evidence from observational studies and randomized, controlled trials suggests that engagement in activities that are cognitively stimulating is beneficial to cognitive functioning. There are many issues and questions that need to be addressed before specific recommendations can be made at the population level or to individual patients. However, older adults should be encouraged to stay active and to try new and challenging activities in general to promote their cognitive and overall health.
Collapse
Affiliation(s)
- Tiffany F Hughes
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara St, Pittsburgh, PA 15213, USA, Tel.: +1 412 647 6619, ,
| |
Collapse
|
32
|
Abstract
OBJECTIVE To examine the association between body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) and risk of dementia and its subtypes in late life. METHODS Participants were members of the Kame Project, a population-based prospective cohort study of 1,836 Japanese Americans living in King County, WA, who had a mean age of 71.8 years and were dementia-free at baseline (1992-1994), and were followed for incident dementia through 2001. Cox proportional hazards models were used to estimate the risk of dementia, Alzheimer disease (AD), and vascular dementia (VaD) controlling for demographic and lifestyle characteristics and vascular comorbidities as a function of baseline BMI, WC, and WHR and change in BMI over time. RESULTS Higher baseline BMI was significantly associated with a reduced risk of AD (hazard ratio [HR] = 0.56, 95% confidence interval [CI] = 0.33-0.97) in the fully adjusted model. Slower rate of decline in BMI was associated with a reduced risk of dementia (HR = 0.37, 95% CI = 0.14-0.98), with the association stronger for those who were overweight or obese (HR = 0.18, 95% CI = 0.05-0.58) compared to normal or underweight (HR = 1.00, 95% CI = 0.18-5.66) at baseline. CONCLUSION Higher baseline body mass index (BMI) and slower declining BMI in late life are associated with a reduced risk of dementia, suggesting that low BMI or a faster decline in BMI in late life may be preclinical indicators of an underlying dementing illness, especially for those who were initially overweight or obese.
Collapse
Affiliation(s)
- T F Hughes
- Department of Psychiatry, University of Pittsburgh, PA 15213, USA.
| | | | | | | | | |
Collapse
|
33
|
Abstract
The baby boom generation is approaching the age of greatest risk for cognitive impairment and dementia. There is growing interest in strategies to modify the environment in midlife to increase the probability of maintaining cognitive health in late life. Several potentially modifiable risk factors have been studied in relation to cognitive impairment and dementia in late life, but methodological limitations of observational research have resulted in some inconsistencies across studies. The most promising strategies are maintaining cardiovascular health, engagement in mental, physical, and social activities, using alcohol in moderation, abstaining from tobacco use, and following a heart-healthy diet. Other factors that may influence cognitive health are occupational attainment, depression, personality, exposure to general anesthesia, head injury, postmenopausal hormone therapy, non-steroidal anti-inflammatory medications, and nutritional supplements such as antioxidants. Some long-term observational studies initiated in midlife or earlier, and some randomized controlled trials, have examined the effects of specific cognitive health promotion behaviors in midlife on the risk of cognitive impairment in late life. Overall, these studies provide limited support for risk reduction at this time. Recommendations and challenges for developing effective strategies to reduce the burden of cognitive impairment and dementia in the future are discussed.
Collapse
Affiliation(s)
- Tiffany F Hughes
- Departments of Psychiatry (T.F.H., M.G.) and Neurology (M.G.), School of Medicine, and the Department of Epidemiology (M.G.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | |
Collapse
|
34
|
Hughes TF, Andel R, Small BJ, Borenstein AR, Mortimer JA. The association between social resources and cognitive change in older adults: evidence from the Charlotte County Healthy Aging Study. J Gerontol B Psychol Sci Soc Sci 2008; 63:P241-P244. [PMID: 18689766 DOI: 10.1093/geronb/63.4.p241] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [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] Open
Abstract
We examined associations between multiple aspects of social resources and 5-year change in performance on different domains of cognitive function. Results indicated that lower satisfaction with support was associated with decline in episodic memory performance over 5 years. We also found significant interactions between age and social networks of family and friends and satisfaction with support for the separate cognitive domains. The results suggest that social resources may be differentially important for cognitive change but that different cognitive domains respond in a similar pattern to social resources.
Collapse
Affiliation(s)
- Tiffany F Hughes
- School of Aging Studies, University of South Florida, 4202 East Fowler Avenue, MHC 1300, Tampa, FL 33620, USA.
| | | | | | | | | |
Collapse
|
35
|
Bielak AAM, Hughes TF, Small BJ, Dixon RA. It's Never Too Late to Engage in Lifestyle Activities: Significant Concurrent but not Change Relationships Between Lifestyle Activities and Cognitive Speed. ACTA ACUST UNITED AC 2007; 62:P331-9. [DOI: 10.1093/geronb/62.6.p331] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
36
|
Costa DA, Cracchiolo JR, Bachstetter AD, Hughes TF, Bales KR, Paul SM, Mervis RF, Arendash GW, Potter H. Enrichment improves cognition in AD mice by amyloid-related and unrelated mechanisms. Neurobiol Aging 2007; 28:831-44. [PMID: 16730391 DOI: 10.1016/j.neurobiolaging.2006.04.009] [Citation(s) in RCA: 170] [Impact Index Per Article: 10.0] [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: 05/13/2005] [Revised: 03/31/2006] [Accepted: 04/07/2006] [Indexed: 11/27/2022]
Abstract
Lifelong cognitive stimulation is associated with a lower risk of Alzheimer's disease (AD), but causality is difficult to prove. We therefore sought to investigate the preventative potential of environmental enrichment (EE) using mice expressing both human mutant presenilin-1 and the amyloid precursor protein (PS1/PDAPP). At weaning, mice were placed into either an enriched or standard housing environment. Behavioral testing at 4.5-6 months showed that environmentally enriched PS1/PDAPP mice outperformed mice in standard housing, and were behaviorally indistinguishable from non-transgenic mice across multiple cognitive domains. PS1/PDAPP mice exposed to both environmental enrichment and behavioral testing, but not to EE alone, showed 50% less brain beta-amyloid without improved dendritic morphology. Microarray analysis revealed large enrichment-induced changes in hippocampal expression of genes/proteins related to Abeta sequestration and synaptic plasticity. These results indicate that EE protects against cognitive impairment in AD transgenic mice through a dual mechanism, including both amyloid dependent and independent mechanisms.
Collapse
Affiliation(s)
- David A Costa
- Johnnie B. Byrd Sr. Alzheimer's Center and Research Institute, Tampa, FL 33647, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Abstract
The aim of this review is to present factors that are relevant to cognitive decline and risk of dementia in later life. With longer life expectancy, the likelihood of experiencing age-related cognitive difficulties has increased. Maintaining normal cognitive function is necessary for successful performance of activities of daily living and independence in later life. Although cognitive decline and dementia are sometimes unavoidable, there are ways in which people can modify their risk of these outcomes. Furthermore, the authors suggest that factors contributing to deviations from homeostasis may have adverse effects on brain health and possibly increase the risk of cognitive decline and dementia.
Collapse
Affiliation(s)
- Ross Andel
- University of South Florida, School of Aging Studies, Tampa, FL 33620, USA
| | - Tiffany F Hughes
- University of South Florida, School of Aging Studies, Tampa, FL 33620, USA
| | - Michael Crowe
- University of Alabama at Birmingham, Department of Psychology, Birmingham, AL 35294-2100, USA
| |
Collapse
|
38
|
Sawyer WT, Hughes TF, Eckel FM. Pharmacy staff training and development: upside-down thinking in a changing profession. Top Hosp Pharm Manage 1992; 12:1-8. [PMID: 10128699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
We suggest that the most fundamental change in staff development that must occur is recognition of the need for a professional belief system as the basis for any pharmaceutical care activity. Values derived from fundamental moral ideals and professional beliefs foster the development of attitudes and behaviors. It would be wrong to suggest or imply that such a change need only occur in postbaccalaureate training. The development of personal and professional value systems in existing primary professional training programs is inadequate--we do not yet do enough to develop people before they enter practice. Nevertheless, to say that this failure of the professional education system precludes us from taking action within professional departments is unwise. The primary skills that must be developed during the next decade involve the ability of the practitioner to competently make informed, patient-specific decisions necessary for effective pharmaceutical care. Such decisions are made not only on the basis of a practitioner's knowledge but on the basis of his or her beliefs and values as well. The practitioner also must be willing to assume responsibility for the consequences of those decisions. The pharmacist who professes to deliver pharmaceutical care can no longer be shielded by assigning to the physician the ultimate responsibility for the patient's drug-therapy outcomes. Facilitating the development of a value system and attitude that enhance the pharmacist's ability to make such decisions must be a principal focus of staff training and development in the coming years.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- W T Sawyer
- University of North Carolina at Chapel Hill
| | | | | |
Collapse
|
39
|
|
40
|
Hughes TF, Eckel FM. Ethical issues associated with managed care pharmacy services. Top Hosp Pharm Manage 1990; 10:30-8. [PMID: 10128576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The authors' purpose in raising these issues and questions is not to provide answers for the profession. We recognize that answers must be derived from a process that includes input from many individuals, and from many sectors of the profession. We also recognize that the pharmacist practicing today realizes that the health care system is changing. We believe that the code of ethics supporting our profession must be revised to reflect these changes to provide more meaningful guidance for pharmacists confronting difficult contemporary issues and dilemmas. We have tried to show that pharmacists working in the HMO setting may face unique problems that must be considered by a revised code of ethics. We are pleased that APhA has begun this process of revision.
Collapse
Affiliation(s)
- T F Hughes
- School of Pharmacy, University of North Carolina, Chapel Hill
| | | |
Collapse
|
41
|
Rosman AW, Leathers CA, Hughes TF. Program analysis and evaluation. Part II: A case study. Curr Concepts Hosp Pharm Manage 1988; 9:7-13. [PMID: 10280742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|
42
|
Hughes TF. Resource management: the key to doing more with less. Top Hosp Pharm Manage 1986; 6:1-13. [PMID: 10314185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|
43
|
Hughes TF, Moore B. Program analysis and evaluation. Part 1: A conceptual model. Curr Concepts Hosp Pharm Manage 1986; 8:7-12. [PMID: 10300999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
|
44
|
Hughes TF. The economics of home health care. Top Hosp Pharm Manage 1984; 4:9-15. [PMID: 10314101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|
45
|
Hughes TF. Objectives of an effective inventory control system. Am J Hosp Pharm 1984; 41:2078-85. [PMID: 6496501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Quantitative decision-making processes are examined as they relate to hospital pharmacy inventory control. The objective of an inventory-control system is to make inventory decisions that minimize the total cost of inventory, which is distinctly different from minimizing inventory. It is often more expensive to run out of an item (and thus be forced to obtain it through more expensive channels) than simply to keep more units in stock. Several models have been proposed in the literature for minimizing the total cost of inventory through the use of an economic order quantity, which attempts to balance the carrying costs of inventory with the cost of running out of an item. Most pharmacy inventory decisions involve replenishment--how much to order, when to decide to order, and when to place the order. There are three costs associated with pharmacy inventory: (1) carrying costs, (2) shortage costs, and (3) replenishment costs. Many of the proposed models (which are discussed in detail in the article) make certain assumptions that do not hold in the realm of hospital pharmacy. For instance, the "costs" associated with running out of a drug product used in critical care might well involve increased morbidity and mortality, clearly an unacceptable situation. However, the basic tenets of these inventory-control systems should be examined by hospital pharmacy managers and applied when appropriate. The availability of microcomputers and relatively powerful spreadsheets will increase the utility of complex models of inventory control that are too complicated for manual calculations.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
|
46
|
Hughes TF. The utility of models in hospital pharmacy management. Top Hosp Pharm Manage 1983; 3:20-35. [PMID: 10314040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|