scholarly journals Markers of cognitive reserve and dementia incidence in the English Longitudinal Study of Ageing

2020 ◽  
pp. 1-9 ◽  
Author(s):  
Pamela Almeida-Meza ◽  
Andrew Steptoe ◽  
Dorina Cadar
Keyword(s):  
Longitudinal Study ◽  
Cognitive Reserve ◽  
Proportional Hazards ◽  
Leisure Activities ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Ageing Population ◽  
Dementia Incidence ◽  
English Longitudinal Study

Background In the current climate of an ageing population, it is imperative to identify preventive measures for dementia. Aims We implemented a multifaceted index of cognitive reserve markers and investigated dementia incidence over 15 years of follow-up in a representative sample of the English population. Method Data were 12 280 participants aged ≥50 years from the English Longitudinal Study of Ageing, free from dementia at their baseline assessments during wave 1 (2002–2003), 3 (2006–2007) or 4 (2008–2009), and followed up until wave 8 (2016–2017). The Cognitive Reserve Index was constructed as a composite measure of education, occupation and leisure activities, using a standardised questionnaire. Cox proportional hazards regression models were used to estimate the hazard ratios of dementia in relation to cognitive reserve levels (low, medium and high) and its components (education, occupation and leisure activities). Results During the follow-up period, 602 participants aged 56–99 years developed dementia. Higher levels of cognitive reserve (hazard ratio 0.65, 95% CI 0.48–0.89, P = 0.008) were associated with a lower risk of dementia. An individual analysis of its components showed that higher levels of education (hazard ratio 0.56, 95% CI 0.36–0.88, P = 0.012), occupation (hazard ratio 0.72, 95% CI 0.56–0.91, P = 0.008) and leisure activities (hazard ratio 0.74, 95% CI 0.56–0.99, P = 0.047) were predictive of a reduced dementia risk, with the first two components particularly protective in younger participants (<85 years). Conclusions This study showed a reduced risk of dementia for individuals with a higher level of cognitive reserve, represented by higher education, complex occupations and multifaceted level of leisure activities.

scholarly journals MARKERS OF COGNITIVE RESERVE AND DEMENTIA INCIDENCE IN THE ENGLISH LONGITUDINAL STUDY OF AGEING

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S620-S620
Author(s):  
Pamela Almeida-Meza ◽  
Pamela Almeida-Meza ◽  
Andrew Steptoe ◽  
Dorina Cadar
Keyword(s):  
Longitudinal Study ◽  
Cognitive Reserve ◽  
Leisure Activities ◽  
Population Data ◽  
Composite Measure ◽  
Dementia Risk ◽  
Dementia Incidence ◽  
English Population ◽  
English Longitudinal Study

Abstract We investigated a multi-faceted index of cognitive reserve (CR), in relation to dementia incidence over 15 years follow-up in a representative sample of the English population. Data were 12,293 participants aged 50+ from the English Longitudinal Study of Ageing, dementia-free at baseline. CR was derived as a composite measure of education, occupation and leisure activities using a standardised questionnaire. From the overall sample, 603 participants developed dementia. Higher CR levels were associated with lower dementia risk (medium CR: HR 0.72, 95% CI 0.59-0.88, p=0.002 and high CR: HR 0.73, 95% CI 0.58-0.90, p=0.005) compared with lowest levels. These associations were independent of sex, marital status, wealth, smoking, depressive symptoms and poor physical health. Further individual analyses of CR sub-components showed that leisure activities (HR 0.72, 95% CI 0.56-0.91, p=0.007) were linked with reduced dementia risk, contributing to a higher CR and increased overall mental resilience.

scholarly journals The Role of Leisure Activities as Markers of Cognitive Reserve on Dementia Risk in English Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 664-664
Author(s):  
Pamela Almeida Meza ◽  
Andrew Steptoe ◽  
Dorina Cadar
Keyword(s):  
Marital Status ◽  
Cognitive Reserve ◽  
Proportional Hazards ◽  
Leisure Activities ◽  
Cox Proportional Hazards ◽  
Dementia Risk ◽  
The Social ◽  
Social Type

Abstract We examined the frequency of participation in cognitive and social type of leisure activities in association with dementia risk over 15 years of follow-up in 12,280 participants aged 50+ from the English Longitudinal Study of Ageing. Cox proportional hazards regression models were used to estimate the hazard of dementia in relation to the cognitive and social type of leisure activities as well as their interactions with sex and marital status. Medium and higher levels of engagement in cognitive leisure activities were associated with a lower risk of dementia. An analysis of the social type of leisure activities showed a similar pattern with protection for higher levels of engagement in a model adjusted for sex and marital status but further explained by wealth. This study shows a reduced risk of dementia for individuals with higher levels of engagement in cognitively stimulating activities, that may preserve cognitive reserve until later in life.

Persistent emotional distress after a first-time myocardial infarction and its association to late cardiovascular and non-cardiovascular mortality

2019 ◽  
Vol 26 (14) ◽  
pp. 1510-1518 ◽  
Author(s):  
Claudia T Lissåker ◽  
Fredrika Norlund ◽  
John Wallert ◽  
Claes Held ◽  
Erik MG Olsson
Keyword(s):  
Myocardial Infarction ◽  
Confidence Interval ◽  
Emotional Distress ◽  
Cardiovascular Mortality ◽  
Proportional Hazards ◽  
Specific Treatment ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
First Time

Background Patients with symptoms of depression and/or anxiety – emotional distress – after a myocardial infarction (MI) have been shown to have worse prognosis and increased healthcare costs. However, whether specific subgroups of patients with emotional distress are more vulnerable is less well established. The purpose of this study was to identify the association between different patterns of emotional distress over time with late cardiovascular and non-cardiovascular mortality among first-MI patients aged <75 years in Sweden. Methods We utilized data on 57,602 consecutive patients with a first-time MI from the national SWEDEHEART registers. Emotional distress was assessed using the anxiety/depression dimension of the European Quality of Life Five Dimensions questionnaire two and 12 months after the MI, combined into persistent (emotional distress at both time-points), remittent (emotional distress at the first follow-up only), new (emotional distress at the second-follow up only) or no distress. Data on cardiovascular and non-cardiovascular mortality were obtained until the study end-time. We used multiple imputation to create complete datasets and adjusted Cox proportional hazards models to estimate hazard ratios. Results Patients with persistent emotional distress were more likely to die from cardiovascular (hazard ratio: 1.46, 95% confidence interval: 1.16, 1.84) and non-cardiovascular causes (hazard ratio: 1.54, 95% confidence interval: 1.30, 1.82) than those with no distress. Those with remittent emotional distress were not statistically significantly more likely to die from any cause than those without emotional distress. Discussion Among patients who survive 12 months, persistent, but not remittent, emotional distress was associated with increased cardiovascular and non-cardiovascular mortality. This indicates a need to identify subgroups of individuals with emotional distress who may benefit from further assessment and specific treatment.

scholarly journals Metformin vs sulfonylurea use and risk of dementia in US veterans aged ≥65 years with diabetes

Neurology ◽  
2017 ◽  
Vol 89 (18) ◽  
pp. 1877-1885 ◽  
Author(s):  
Ariela R. Orkaby ◽  
Kelly Cho ◽  
Jean Cormack ◽  
David R. Gagnon ◽  
Jane A. Driver
Keyword(s):  
Lower Risk ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Confounding By Indication ◽  
Cox Proportional Hazards Models ◽  
Incident Dementia ◽  
Us Veterans

Objective:To determine whether metformin is associated with a lower incidence of dementia than sulfonylureas.Methods:This was a retrospective cohort study of US veterans ≥65 years of age with type 2 diabetes who were new users of metformin or a sulfonylurea and had no dementia. Follow-up began after 2 years of therapy. To account for confounding by indication, we developed a propensity score (PS) and used inverse probability of treatment weighting (IPTW) methods. Cox proportional hazards models estimated the hazard ratio (HR) of incident dementia.Results:We identified 17,200 new users of metformin and 11,440 new users of sulfonylureas. Mean age was 73.5 years and mean HbA1c was 6.8%. Over an average follow-up of 5 years, 4,906 cases of dementia were diagnosed. Due to effect modification by age, all analyses were conducted using a piecewise model for age. Crude hazard ratio [HR] for any dementia in metformin vs sulfonylurea users was 0.67 (95% confidence interval [CI] 0.61–0.73) and 0.78 (95% CI 0.72–0.83) for those <75 years of age and ≥75 years of age, respectively. After PS IPTW adjustment, results remained significant in veterans <75 years of age (HR 0.89; 95% CI 0.79–0.99), but not for those ≥75 years of age (HR 0.96; 95% CI 0.87–1.05). A lower risk of dementia was also seen in the subset of younger veterans who had HbA1C values ≥7% (HR 0.76; 95% CI 0.63–0.91), had good renal function (HR 0.86; 95% CI 0.76–0.97), and were white (HR 0.87; 95% CI 0.77–0.99).Conclusions:After accounting for confounding by indication, metformin was associated with a lower risk of subsequent dementia than sulfonylurea use in veterans <75 years of age. Further work is needed to identify which patients may benefit from metformin for the prevention of dementia.

scholarly journals Higher risk of dementia in English older individuals who are overweight or obese

2020 ◽  
Vol 49 (4) ◽  
pp. 1353-1365 ◽  
Author(s):  
Yixuan Ma ◽  
Olesya Ajnakina ◽  
Andrew Steptoe ◽  
Dorina Cadar
Keyword(s):  
Body Weight ◽  
Abdominal Obesity ◽  
Central Obesity ◽  
Proportional Hazards ◽  
Normal Weight ◽  
Cox Proportional Hazards ◽  
Older Individuals ◽  
Obese Women ◽  
Dementia Incidence

Abstract Background Several risk factors contribute to dementia, but the role of obesity remains unclear. This study investigated whether increased body weight or central obesity were associated with a higher risk of developing dementia in a representative sample of older English adults. Methods We studied 6582 participants from the English Longitudinal Study of Ageing (ELSA) who were aged ≥50 years and were dementia-free at baseline, that being either wave 1 (2002–2003) for study members who started at wave 1, or at either wave 2 (2004–2005) or 4 (2008–2009) for those who began the study as refreshment samples. Body mass index (BMI) was measured at baseline and categorized into normal weight (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2) and obese (≥30 kg/m2). Central obesity was defined as a waist circumference (WC) &gt;88 cm for women and &gt;102 cm for men. Cumulative incidence of dementia was ascertained based on physician-diagnosed dementia, an overall score &gt;3.38 on the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and Hospital Episodes Statistics (HES) data at every ELSA wave from baseline until wave 8 (2016–2017). Cox proportional hazards models were used to assess the association between baseline BMI levels or abdominal obesity in relation to dementia incidence during the mean follow-up period of 11 years. Results From the overall sample, 6.9% (n = 453) of participants developed dementia during the follow-up period of maximum 15 years (2002–2017). Compared with participants with normal weight, those who were obese at baseline had an elevated risk of dementia incidence [hazard ratio (HR) = 1.34, 95% confidence interval (CI) 1.07–1.61] independent of sex, baseline age, apolipoprotein E-ε4 (APOE-ε4), education, physical activity, smoking and marital status. The relationship was slightly accentuated after additionally controlling for hypertension and diabetes (HR = 1.31, 95% CI 1.03–1.59). Women with central obesity had a 39% greater risk of dementia compared with non-central obese women (HR = 1.39, 95% CI 1.12–1.66). When compared with a normal BMI and WC group, the obese and high WC group had 28% (HR = 1.28, 95% CI 1.03–1.53) higher risk of dementia. Conclusions Our results suggest that having an increased body weight or abdominal obesity are associated with increased dementia incidence. These findings have significant implications for dementia prevention and overall public health.

Computerized histomorphometric features of glandular architecture predict risk of biochemical recurrence following radical prostatectomy: A multisite study.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 5060-5060 ◽  
Author(s):  
Patrick Leo ◽  
Andrew Janowczyk ◽  
Robin Elliott ◽  
Nafiseh Janaki ◽  
Rakesh Shiradkar ◽  
...  
Keyword(s):  
High Risk ◽  
Radical Prostatectomy ◽  
Biochemical Recurrence ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Gleason Grade ◽  
Training Set ◽  
Validation Set

5060 Background: Following a radical prostatectomy (RP) for prostate cancer, a patient may experience biochemical recurrence (BCR), defined as two consecutive prostate specific antigen (PSA) readings > 0.2 ng/mL. BCR is correlated with metastasis and disease specific survival. Extant molecular based companion diagnostic tests for predicting risk of BCR and disease progression tend to be expensive and tissue destructive. We sought to evaluate whether computer extracted features of glandular architecture from routine digitized H&E slides could predict post-RP BCR risk. Methods: RP specimens from 683 patients (184 with BCR, 499 without) with post-surgical PSA follow-up information were gathered from six sites. Median non-BCR follow-up was 3.2 years. A representative tumor area was annotated on the diagnostic H&E slide of each patient. 324 (131 BCR) patients from two sites formed the training set. The other 359 (53 BCR) patients formed the validation set. Glands were segmented by a deep learning model. 216 features describing gland arrangement, shape, and disorder were then extracted. An elastic net Cox proportional hazards model was constructed from the training set using the top 10 stable features identified via feature selection. Risk score thresholds were chosen on the training set to stratify patients into low-, medium-, or high-risk. Validation set results were evaluated by the log-rank test and hazard ratio. For the 172 (37 BCR) patients for whom Gleason grade and preoperative PSA values were available, risk classifications were compared using Cox proportional hazards regression. Results: Nine of the top features were gland shape features and one was a gland arrangement feature. The hazard ratio between the low- and high-risk groups on the validation set was 3.04 (p < 0.05). The histomorphometric classifier was predictive of BCR (p < 0.05, hazard ratio = 1.63) independent of Gleason grade group and preoperative PSA in multivariate testing. Conclusions: Computer extracted features of gland morphology can stratify post-RP patients by BCR risk. Our computerized histomorphometric model could serve as a prognostic tool in the post-RP setting.[Table: see text]

Hemorrhage From Arteriovenous Malformations During Pregnancy

Neurosurgery ◽  
2012 ◽  
Vol 71 (2) ◽  
pp. 349-356 ◽  
Author(s):  
Bradley A. Gross ◽  
Rose Du
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Venous Drainage ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Cox Proportional Hazards Model ◽  
Relative Paucity ◽  
Increased Risk ◽  
Risk Of Hemorrhage

Abstract BACKGROUND: Previous hemorrhage, deep venous drainage, and deep location are established risk factors for arteriovenous malformation (AVM) hemorrhage. Although pregnancy is an assumed risk factor, there is a relative paucity of data to support this neurosurgical tenet. OBJECTIVE: To elucidate the hemorrhage rate of AVMs during pregnancy. METHODS: We reviewed the records of 54 women with an angiographic diagnosis of an AVM at our institution. Annual hemorrhage rates were calculated as the ratio of the number of bleeds to total number of patient-years of follow-up. Patient-years of follow-up were tallied assuming lesion presence from birth until AVM obliteration. The Cox proportional hazards model for hemorrhage with pregnancy as the time-dependent variable was used to calculate the hazard ratio. RESULTS: Five hemorrhages in 4 patients occurred over 62 pregnancies, yielding a hemorrhage rate of 8.1% per pregnancy or 10.8% per year. Over the remaining 2461.3 patient-years of follow-up, only 28 hemorrhages occurred, yielding an annual hemorrhage rate of 1.1%. The hazard ratio for hemorrhage during pregnancy was 7.91 (P = 2.23 × 10−4), increasing to 18.12 (P = 7.31 × 10−5) when limiting the analysis to patient follow-up up to age 40. CONCLUSION: Because of the increased risk of hemorrhage from AVMs during pregnancy, we recommend intervention in women who desire to bear children, particularly if the AVM has bled. If the AVM is discovered during pregnancy, we recommend early intervention if it has ruptured; if it is unruptured, we recommend comprehensive counseling, weighing risks of intervention against continuation of pregnancy without intervention.

Increased risk of stroke after trigeminal neuralgia – a population-based follow-up study

Cephalalgia ◽  
2011 ◽  
Vol 31 (8) ◽  
pp. 937-942 ◽  
Author(s):  
Shin-Liang Pan ◽  
Li-Sheng Chen ◽  
Ming-Fang Yen ◽  
Yueh-Hsia Chiu ◽  
Hsiu-Hsi Chen
Keyword(s):  
Trigeminal Neuralgia ◽  
Proportional Hazards ◽  
Underlying Mechanism ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Follow Up Study ◽  
Medical Disorders ◽  
Increased Risk

Background: There are no reports on the risk of stroke after trigeminal neuralgia (TN). The aim of this population-based follow-up study was to investigate whether the occurrence of TN is associated with a higher risk of developing stroke. Methods: A total of 1453 people with at least three ambulatory visits in 2001 with the principal diagnosis of TN were enrolled in the TN cohort. The non-TN cohort consisted of 5812 age- and sex-matched, randomly sampled subjects without TN. The 2-year stroke-free survival rate between the two groups was compared using the Kaplan-Meier method. The Cox proportional hazards regression model was used to estimate the hazard ratio of stroke after adjustment for demographic and clinical covariates. Results: In the TN cohort, 73 patients developed stroke during follow-up, while in the non-TN cohort, 157 subjects suffered a stroke. The crude hazard ratio of stroke for the subjects with TN was 1.86 (95% CI, 1.41–2.45; p < 0.0001). The adjusted hazard ratio was 1.76 (95% CI, 1.33–2.33; p < 0.0001) after adjusting for demographic characteristics and comorbid medical disorders. Conclusion: This study showed a significantly increased risk of developing stroke after TN. Further studies are needed to investigate the underlying mechanism of this association.

scholarly journals The Relationship between Scabies and Stroke: A Population-Based Nationwide Study

2019 ◽  
Vol 16 (18) ◽  
pp. 3491 ◽  
Author(s):  
Meng-Huan Wu ◽  
Chien-Yu Li ◽  
Huichin Pan ◽  
Yu-Chieh Lin
Keyword(s):  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Control Group ◽  
Research Database ◽  
Newly Diagnosed ◽  
Nationwide Study ◽  
The Relationship

Background: Scabies is a commonly occurring infectious skin infestation that substantially impacts the quality of life, while stroke, which consists of a neurological deficit resulting from a lack of blood flow to the brain, carries sizable economic costs. The pathophysiologic mechanisms underlying both diseases involve inflammatory processes that are mediated by the immune system; however, no prior research has been conducted to explore the relationship between the two conditions. Methods: This population-based nationwide study utilized data from the National Health Insurance Research Database (NHIRD) of Taiwan for a total of 6628 scabies patients, who comprised a scabies group, and a randomly selected cohort of 26,509 matching patients, who served as a control group. More specifically, the medical records for the patients in both groups were checked for seven years to identify any new cases of stroke within that seven-year follow-up period. The hazard ratio (HR) of stroke for the follow-up period was then calculated using Cox proportional hazards regressions, while comorbidities and demographic characteristics were likewise analyzed. Results: During the follow-up period, 2892 patients, or 8.7%, of the overall total of 33,137 patients included in the study were newly diagnosed with a stroke. Of those newly diagnosed stroke patients, 833 were from the scabies group, and 2059 were from the control group, accounting for 12.6% and 7.8%, respectively, of the individuals in each group. With a crude hazard ratio of 1.67, the patients in the scabies group had a significantly higher risk of subsequent stroke than those in the control group, although the adjusted hazard ratio (aHR) for the scabies patients, which was determined by adjusting for covariates, was only 1.32 (95% confidence interval (CI): 1.21–1.43). Conclusions: The results of the study indicated an elevated risk of stroke among scabies patients, an association that might be contributed to by immunopathological factors. This information could serve as a reminder to clinicians to remain alert to any indications of neurological impairment in patients previously infected with scabies.

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