scholarly journals Cognitive dispersion and ApoEe4 genotype predict dementia diagnosis in 8-year follow-up of the oldest-old

2020 ◽  
Author(s):  
Tam Watermeyer ◽  
Jantje Goerdten ◽  
Boo Johansson ◽  
Graciela Muniz-Terrera
Keyword(s):  
Cognitive Performance ◽  
Cox Regression ◽  
Oldest Old ◽  
Cost Effective ◽  
Carrier Status ◽  
Dementia Diagnosis ◽  
Cognitive Domains ◽  
Dementia Incidence ◽  
Composite Scores

Abstract Background Cognitive dispersion, or inconsistencies in performance across cognitive domains, has been posited as a cost-effective tool to predict conversion to dementia in older adults. However, there is a dearth of studies exploring cognitive dispersion in the oldest-old (>80 years) and its relationship to dementia incidence. Objective The main aim of this study was to examine whether higher cognitive dispersion at baseline was associated with dementia incidence within an 8-year follow-up of very old adults, while controlling for established risk factors and suggested protective factors for dementia. Methods Participants (n = 468) were from the Origins of Variance in the Old-Old: Octogenarian Twins study, based on the Swedish Twin Registry. Cox regression analyses were performed to assess the association between baseline cognitive dispersion scores and dementia incidence, while controlling for sociodemographic variables, ApoEe4 carrier status, co-morbidities, zygosity and lifestyle engagement scores. An additional model included a composite of average cognitive performance. Results Cognitive dispersion and ApoEe4 were significantly associated with dementia diagnosis. These variables remained statistically significant when global cognitive performance was entered into the model. Likelihood ratio tests revealed that cognitive dispersion and cognitive composite scores entered together in the same model was superior to either predictor alone in the full model. Conclusions The study underscores the usefulness of cognitive dispersion metrics for dementia prediction in the oldest-old and highlights the influence of ApoEe4 on cognition in very late age. Our findings concur with others suggesting that health and lifestyle factors pose little impact upon cognition in very advanced age.

scholarly journals Sleep duration and all-cause mortality in the elderly in China: a population-based cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yanfeng Ren ◽  
Maohua Miao ◽  
Wei Yuan ◽  
Jiangwei Sun
Keyword(s):  
Cohort Study ◽  
Sleep Duration ◽  
Dose Response ◽  
Cox Regression ◽  
Oldest Old ◽  
The Elderly ◽  
Response Analysis ◽  
Short Sleep Duration ◽  
All Cause Mortality

Abstract Background Although a U-shaped association between sleep duration and all-cause mortality has been found in general population, its association in the elderly adults, especially in the oldest-old, is rarely explored. Methods In present cohort study, we prospectively explore the association between sleep duration and all-cause mortality among 15,092 participants enrolled in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2005 to 2019. Sleep duration and death information was collected by using structured questionnaires. Cox regression model with sleep duration as a time-varying exposure was performed to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs). The dose-response association between them was explored via a restricted cubic spline function. Results During an average follow-up of 4.51 (standard deviation, SD: 3.62) years, 10,768 participants died during the follow-up period. The mean (SD) age of the participants was 89.26 (11.56) years old. Compared to individuals with moderate sleep duration (7–8 hours), individuals with long sleep duration (> 8 hours) had a significantly higher risk of all-cause mortality (HR: 1.13, 95%CI: 1.09–1.18), but not among individuals with short sleep duration (≤ 6 hours) (HR: 1.02, 95%CI: 0.96–1.09). Similar results were observed in subgroup analyses based on age and gender. In the dose-response analysis, a J-shaped association was observed. Conclusions Sleep duration was associated with all-cause mortality in a J-shaped pattern in the elderly population in China.

Cognitive performance and the course of depressive symptoms over 7 years of follow-up: the SMART-MR study

2014 ◽  
Vol 45 (8) ◽  
pp. 1741-1750 ◽  
Author(s):  
M. Kooistra ◽  
N. P. A. Zuithoff ◽  
A. M. Grool ◽  
M. Zinsmeester ◽  
G. J. Biessels ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Cognitive Performance ◽  
Estimating Equation ◽  
Multiple Time ◽  
Information Processing Speed ◽  
Cognitive Domains ◽  
Interaction Terms ◽  
Multiple Time Points ◽  
Mr Study

BackgroundDepressive symptoms and cognitive impairment often co-occur, but their interactive relationship is complex and the direction of causation is still a topic of research. We examined the influence of cognitive performance on the course of depressive symptoms during 7 years of follow-up in patients with vascular disease.MethodWithin the SMART-MR study, 736 patients (mean age 62 ± 10 years) had neuropsychological assessment on four cognitive domains at baseline [memory (MEM), working memory (WMEM), executive functioning (EXEC), and information processing speed (SPEED)]. Depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9) at baseline and every 6 months during 7 years of follow-up. Generalized Estimating Equation (GEE) models were used to assess the association between cognitive performance with depressive symptoms at multiple time points during follow-up. Interaction terms between the respective cognitive domains and time was included to examine if the course of depressive symptoms differed according to baseline cognitive performance.ResultsThe GEE analyses showed no significant interactions between the respective cognitive domains and time indicating no different course of depressive symptoms according to baseline cognitive performance. Lower MEM, EXEC or SPEED, but not WMEM performance, was significantly associated with more depressive symptoms during follow-up per z score decrease: MEM [B = 0.70, 95% confidence interval (CI) 0.35–1.05]; EXEC (B = 0.88, 95% CI 0.41–1.36), and SPEED (B = 0.57, 95% CI 0.21–0.92).ConclusionsPoorer cognitive performance on the domains MEM, EXEC and SPEED, but not WMEM, was associated with higher levels of depressive symptoms over 7 years of follow-up, but not with a different course of depressive symptoms over time.

scholarly journals Drug prescriptions and dementia incidence: a medication-wide association study of 17000 dementia cases among half a million participants

2021 ◽  
pp. jech-2021-217090
Author(s):  
Tim Wilkinson ◽  
Christian Schnier ◽  
Kathryn Bush ◽  
Kristiina Rannikmäe ◽  
Ronan A Lyons ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Association Study ◽  
Hospital Admissions ◽  
Cox Regression ◽  
Mortality Data ◽  
Care Hospital ◽  
Dementia Incidence ◽  
Primary Care Hospital

BackgroundPrevious studies have suggested that some medications may influence dementia risk. We conducted a hypothesis-generating medication-wide association study to investigate systematically the association between all prescription medications and incident dementia.MethodsWe used a population-based cohort within the Secure Anonymised Information Linkage (SAIL) databank, comprising routinely-collected primary care, hospital admissions and mortality data from Wales, UK. We included all participants born after 1910 and registered with a SAIL general practice at ≤60 years old. Follow-up was from each participant’s 60th birthday to the earliest of dementia diagnosis, deregistration from a SAIL general practice, death or the end of 2018. We considered participants exposed to a medication if they received ≥1 prescription for any of 744 medications before or during follow-up. We adjusted for sex, smoking and socioeconomic status. The outcome was any all-cause dementia code in primary care, hospital or mortality data during follow-up. We used Cox regression to calculate hazard ratios and Bonferroni-corrected p values.ResultsOf 551 344 participants, 16 998 (3%) developed dementia (median follow-up was 17 years for people who developed dementia, 10 years for those without dementia). Of 744 medications, 221 (30%) were associated with dementia. Of these, 217 (98%) were associated with increased dementia incidence, many clustering around certain indications. Four medications (all vaccines) were associated with a lower dementia incidence.ConclusionsAlmost a third of medications were associated with dementia. The clustering of many drugs around certain indications may provide insights into early manifestations of dementia. We encourage further investigation of hypotheses generated by these results.

scholarly journals Gender Differences in Cognitive Performance in Old Age

GeroPsych ◽  
2014 ◽  
Vol 27 (3) ◽  
pp. 129-134 ◽  
Author(s):  
Marcus Praetorius ◽  
Valgeir Thorvaldsson ◽  
Boo Johansson ◽  
Linda B. Hassing
Keyword(s):  
Gender Differences ◽  
Cognitive Performance ◽  
Old Age ◽  
Twin Study ◽  
Oldest Old ◽  
Cognitive Differences ◽  
Men And Women ◽  
Cognitive Domains ◽  
Very Old Age ◽  
Rate Of Decline

Objective: To examine gender differences in level and change of cognitive performance in the oldest old while accounting for gender differences in longevity. Method: 574 individuals, aged 80 years and older, from the OCTO Twin Study. Five cognitive domains were administered at five occasions at 2-year intervals. Results: There were no cognitive differences between men and women, with the exception that men showed a steeper rate of decline in semantic memory. This effect was driven by men who had developed dementia and declined at a faster rate than women. Conclusion: Our results support previous findings showing minor to nonexisting gender differences in cognition among nondemented individuals in very old age when taking gender differences in longevity into account.

scholarly journals Dementia Risk among Coronavirus Disease Survivors: A Nationwide Cohort Study in South Korea

2021 ◽  
Vol 11 (10) ◽  
pp. 1015
Author(s):  
Hye-Yoon Park ◽  
In-Ae Song ◽  
Tak-Kyu Oh
Keyword(s):  
Cohort Study ◽  
Health Insurance ◽  
South Korea ◽  
Cox Regression ◽  
Control Group ◽  
Dementia Diagnosis ◽  
Dementia Risk ◽  
History Of ◽  
New Onset

We aimed to investigate whether coronavirus disease (COVID-19) survivors were at a higher risk of dementia diagnosis compared to controls at 6 months follow-up. Data pertaining to the period between 1 January and 4 June 2020, were extracted from the National Health Insurance Service (NHIS)-COVID-19 database in South Korea. Data on adults (≥20 years old) with no history of dementia, obtained from the NHIS-COVID-19 database, were included in the study. The endpoint of this study was the development of dementia, which was evaluated from 1 January to 1 December 2020. A total of 306,577 adults were included in the analysis, comprising 7133 COVID-19 survivors and 299,444 individuals in the control group. Among the subjects, new-onset dementia diagnosed in 2020 was recorded in 1.2% (3546 of 306,577). In the covariate-adjusted multivariable Cox regression model, the incidence of dementia among COVID-19 survivors was 1.39-fold higher (hazard ratio: 1.39, 95% confidence interval: 1.05–1.85; p = 0.023) than that in the control group. At approximately 6 months of follow-up, COVID-19 survivors were at a higher risk of dementia compared to other populations in South Korea.

scholarly journals Lithium Receipt and Risk of Dementia in Older Veterans With Bipolar Disorder in the VA Health System

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 543-543
Author(s):  
Benjamin Szymanski ◽  
Eileen Ahearn ◽  
Eric Smith ◽  
Jenefer Jedele ◽  
John McCarthy ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Health System ◽  
Lithium Treatment ◽  
Cox Proportional Hazards ◽  
Fiscal Year ◽  
Dementia Diagnosis ◽  
Medical Comorbidities ◽  
Dementia Incidence ◽  
Increased Risk

Abstract Older adults with bipolar disorder are at increased risk of developing dementia. The literature suggests lithium treatment may reduce the incidence of dementia. This study sought to inform clinical practice in the Veterans Affairs (VA) health system by estimating the effect of past year lithium receipt on dementia incidence among Veterans with bipolar disorder. Divalproex receipt was used as a comparison. Using VA medical records, 121,094 Veterans aged 50 and older with a diagnosis of bipolar disorder but no dementia diagnosis were identified in fiscal years 2005-2019. Follow-up continued until dementia diagnosis, 36 months from the index date, death, or the end of fiscal year 2020, whichever came first. 4347 (3.6%) were diagnosed with dementia during follow-up. Time-varying indicators of receipt of lithium and divalproex in the prior 365 days were calculated for each day, categorized as 301-365, 61-300, 1-60, or 0 days of receipt. Unadjusted Cox proportional hazards regression analyses indicated reduced dementia incidence with 301-365 (HR=0.86, 95% Confidence Interval [95%CI] 0.75-0.99) and 61-300 (HR=0.75, 95%CI 0.65-0.87) days of lithium receipt, compared to 0 days. For divalproex, 301-365 (HR=1.34, 95%CI 1.23-1.47) and 61-300 (HR=1.13, 95%CI 1.03-1.23) days of receipt were each associated with increased dementia incidence. Lithium effects were not statistically significant after adjusting for age, sex, race, ethnicity, medical comorbidities, and antidepressant, antipsychotic, and anxiolytic medication receipt. Divalproex effects remained statistically significant. Past year divalproex, but not lithium, receipt was significantly associated with dementia incidence among VA patients with bipolar disorder when adjusting for demographics and medical comorbidities.

Abstract P052: History of High Cholesterol and Incidence of Dementia: The 90+ Study

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Marcella A Evans ◽  
Claudia H Kawas ◽  
Maria M Corrada
Keyword(s):  
Short Form ◽  
Oldest Old ◽  
College Education ◽  
Aging Brain ◽  
High Cholesterol ◽  
Dementia Risk ◽  
Dementia Incidence ◽  
Neurological Exam ◽  
History Of

Background: Hypercholesterolemia at midlife has been associated with increased dementia risk. However, some studies suggest that this relationship may change with age. It is not known if an association between cholesterol and dementia incidence persists in the oldest-old (people aged 90+) [[Unable to Display Character: –]] the most rapidly growing segment of the population. We examined whether a history of high cholesterol is associated with dementia incidence in The 90+ Study, a longitudinal population-based study of the oldest-old. Methods: We analyzed data from 569 participants who were non-demented at baseline, had one or more follow-up visits, and provided self-reported history of high cholesterol. Participants were evaluated every six months, with dementia diagnosis (DSM-IV criteria) at follow-up determined in a hierarchal manner from: neurological exam, Mini-Mental Status Exam, informant questionnaires, and the Cognitive Abilities Screening Instrument (telephone short form). We used Cox regression to estimate the association between history of high cholesterol and incident dementia, using age as the time scale and adjusting for gender and education. Results: Participants had a mean age of 93.3 years (range 90-103) at baseline and were primarily Caucasian (99%), women (69%), and with at least some college education (77%). 200 participants (35%) reported a history of high cholesterol. After a mean follow-up of 3.3 years (range 0.1-9.0), 224 individuals (39%) were diagnosed with dementia (68% from neurological exam). People who reported a history of high cholesterol at baseline were less likely to develop dementia compared to people without a history of high cholesterol (HR=0.76, 95% CI 0.57[[Unable to Display Character: –]]1.02, p=0.072). Conclusions: Contrary to findings in younger ages, high cholesterol appears to be associated with lower dementia risk in the oldest-old. A potential mechanism could be that with advanced age a compensatory increase in cholesterol synthesis or uptake occurs in order to preserve function of the aging brain, as the cholesterol molecule has a variety of biological roles related to brain health. Further research is needed to analyze direct measurements of serum cholesterol, as well as to examine the effects of a variety of factors (such as use and duration of cholesterol-lowering medications, low cholesterol as a proxy for poor health and frailty, and duration of hypercholesterolemia) on the observed association. Our results imply that target cholesterol levels in the oldest-old may be different from those recommended in younger populations, at least in regards to cognitive health.

The impact of cognitive reserve, cognition and clinical symptoms on psychosocial functioning in first-episode psychoses

2020 ◽  
pp. 1-12 ◽  
Author(s):  
Silvia Amoretti ◽  
Adriane R Rosa ◽  
Gisela Mezquida ◽  
Bibiana Cabrera ◽  
María Ribeiro ◽  
...  
Keyword(s):  
Cognitive Performance ◽  
Verbal Memory ◽  
Negative Symptoms ◽  
Cognitive Reserve ◽  
Clinical Symptoms ◽  
First Episode ◽  
Cognitive Domains ◽  
The Impact ◽  
The Relationship

Abstract Background Functional impairment is a defining feature of psychotic disorders. A range of factors has been shown to influence functioning, including negative symptoms, cognitive performance and cognitive reserve (CR). However, it is not clear how these variables may affect functioning in first-episode psychosis (FEP) patients. This 2-year follow-up study aimed to explore the possible mediating effects of CR on the relationship between cognitive performance or specific clinical symptoms and functional outcome. Methods A prospective study of non-affective FEP patients was performed (211 at baseline and 139 at follow-up). CR was entered in a path analysis model as potential mediators between cognitive domains or clinical symptoms and functioning. Results At baseline, the relationship between clinical variables or cognitive performance and functioning was not mediated by CR. At follow-up, the effect of attention (p = 0.003) and negative symptoms (p = 0.012) assessed at baseline on functioning was partially mediated by CR (p = 0.032 and 0.016), whereas the relationship between verbal memory (p = 0.057) and functioning was mediated by CR (p = 0.014). Verbal memory and positive and total subscales of PANSS assessed at follow-up were partially mediated by CR and the effect of working memory on functioning was totally mediated by CR. Conclusions Our results showed the influence of CR in mediating the relationship between cognitive domains or clinical symptoms and functioning in FEP. In particular, CR partially mediated the relationship between some cognitive domains or clinical symptoms and functioning at follow-up. Therefore, CR could improve our understanding of the long-term functioning of patients with a non-affective FEP.

scholarly journals Anticholinergic Burden and Cognitive Performance in Patients With Schizophrenia: A Systematic Literature Review

2021 ◽  
Vol 12 ◽  
Author(s):  
Rafaella Georgiou ◽  
Demetris Lamnisos ◽  
Konstantinos Giannakou
Keyword(s):  
Cognitive Impairment ◽  
Literature Review ◽  
Cognitive Performance ◽  
Systematic Literature Review ◽  
English Language ◽  
Neurocognitive Performance ◽  
Cognitive Domains ◽  
Language Studies ◽  
Composite Scores ◽  
Anticholinergic Burden

Objective: Cognitive impairment in schizophrenia forms the key cause of the disease's disability, leading to serious functional, and socioeconomic implications. Dopaminergic-cholinergic balance is considered essential to cognitive performance in schizophrenia and patients are often treated with many drugs with anticholinergic properties. This study aims to examine the cognitive impact of anticholinergic burden in patients with schizophrenia.Methods: A systematic literature review was performed on English-language studies published on PubMed, Embase, and Web of Science, from inception to June 2021, to identify research studies that examined the effect of anticholinergic load on cognition in clinically stable patients with schizophrenia. No restrictions on study design, age of participants, or geographical distribution were applied. Two researchers performed independently the screening and shortlisting of the eligible articles. A narrative synthesis of the main characteristics and findings of studies included was reported.Results: In total, 17 articles of varying methodological design met the inclusion criteria. Three of them found statistically significant improvement in cognition after anticholinergic tapering without adverse effects. Thirteen studies found a statistically significant association between high anticholinergic burden and cognitive impairment (neurocognitive composite scores and individual cognitive domains such as learning and memory, executive function, processing speed), apart from a study, related to the specific characteristics of clozapine.Conclusions: Medication with increased anticholinergic load has been found in most of the studies to negatively affect neurocognitive performance of patients with schizophrenia. However, the clinical and methodological heterogeneity of studies included limit our interpretation and conclusions.

Living Alone and Dementia Incidence: A Clinical-Based Study in People With Mild Cognitive Impairment

2018 ◽  
Vol 31 (3) ◽  
pp. 107-113 ◽  
Author(s):  
Giulia Grande ◽  
Davide Liborio Vetrano ◽  
Ilaria Cova ◽  
Simone Pomati ◽  
Daniele Mattavelli ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Ad Hoc ◽  
Cox Regression ◽  
Population Based ◽  
Living Alone ◽  
Living Situation ◽  
Hazard Ratios ◽  
Dementia Incidence

Introduction: Social isolation and living alone have been associated with negative outcomes, especially in the older population. We aim to investigate the effect of living alone on the development of dementia in people with mild cognitive impairment (MCI). Materials and Methods: In this longitudinal study, we enrolled 345 outpatients with MCI evaluated at baseline through a clinical and neuropsychological protocol. Data on living situation (living alone vs. living with someone) were also collected. The development of dementia at follow-up was the outcome of the study. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox regression analyses. Laplace regression was used to model the time-to-dementia diagnosis as a function of living situation. Results: During the follow-up time (mean [SD]: 2.8 [2.2] years), 172 (50%) participants developed dementia. After controlling for age, sex, years of education, MCI subtype, presence of comorbidities, and antidepressant therapy, people with MCI living alone were more likely to develop dementia (HR: 1.5; 95% CI: 1.1-2.1), when compared to those living with someone. In addition, participants with MCI living alone were diagnosed with dementia 1 year earlier than those living with someone ( P = .012). Conclusion: Living alone increases by 50% the risk of developing dementia and anticipates by 1 year the diagnosis in people with MCI. These results, in line with findings of previous population-based studies, emphasize the pivotal role of the living situation in identifying a frailer share of the population at higher risk of dementia to which devote ad hoc assessment and care.

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