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.

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 Supper Timing and Cardiovascular Mortality: The Japan Collaborative Cohort Study

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3389
Author(s):  
Jingyun Tang ◽  
Jia-Yi Dong ◽  
Ehab S. Eshak ◽  
Renzhe Cui ◽  
Kokoro Shirai ◽  
...  
Keyword(s):  
Hemorrhagic Stroke ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Stroke Mortality ◽  
Hazard Ratios ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Study Participants

Evidence on the role of supper timing in the development of cardiovascular disease (CVD) is limited. In this study, we examined the associations between supper timing and risks of mortality from stroke, coronary heart disease (CHD), and total CVD. A total of 28,625 males and 43,213 females, aged 40 to 79 years, free from CVD and cancers at baseline were involved in this study. Participants were divided into three groups: the early supper group (before 8:00 p.m.), the irregular supper group (time irregular), and the late supper group (after 8:00 p.m.). Cox proportional hazards regression models were used to calculate hazard ratios (HRs) for stroke, CHD, and total CVD according to the supper time groups. During the 19-year follow-up, we identified 4706 deaths from total CVD. Compared with the early supper group, the multivariable HR of hemorrhagic stroke mortality for the irregular supper group was 1.44 (95% confidence interval [CI]: 1.05–1.97). There was no significant association between supper timing and the risk of mortality from other types of stroke, CHD, and CVD. We found that adopting an irregular supper timing compared with having dinner before 8:00 p.m. was associated with an increased risk of hemorrhagic stroke mortality.

scholarly journals Bi-directional association between epilepsy and dementia

Neurology ◽  
2020 ◽  
Vol 95 (24) ◽  
pp. e3241-e3247 ◽  
Author(s):  
Maria Stefanidou ◽  
Alexa S. Beiser ◽  
Jayandra Jung Himali ◽  
Teng J. Peng ◽  
Orrin Devinsky ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Secondary Analysis ◽  
Cox Proportional Hazards ◽  
Dementia Risk ◽  
Incident Dementia ◽  
Heart Study ◽  
Allele Status ◽  
Ε4 Allele ◽  
Nested Case Control

ObjectiveTo assess the risk of incident epilepsy among participants with prevalent dementia and the risk of incident dementia among participants with prevalent epilepsy in the Framingham Heart Study (FHS).MethodsWe analyzed prospectively collected data in the Original and Offspring FHS cohorts. To determine the risk of developing epilepsy among participants with dementia and the risk of developing dementia among participants with epilepsy, we used separate, nested, case–control designs and matched each case to 3 age-, sex- and FHS cohort–matched controls. We used Cox proportional hazards regression analysis, adjusting for sex and age. In secondary analysis, we investigated the role of education level and APOE ε4 allele status in modifying the association between epilepsy and dementia.ResultsA total of 4,906 participants had information on epilepsy and dementia and dementia follow-up after age 65. Among 660 participants with dementia and 1,980 dementia-free controls, there were 58 incident epilepsy cases during follow-up. Analysis comparing epilepsy risk among dementia cases vs controls yielded a hazard ratio (HR) of 1.82 (95% confidence interval 1.05–3.16, p = 0.034). Among 43 participants with epilepsy and 129 epilepsy-free controls, there were 51 incident dementia cases. Analysis comparing dementia risk among epilepsy cases vs controls yielded a HR of 1.99 (1.11–3.57, p = 0.021). In this group, among participants with any post–high school education, prevalent epilepsy was associated with a nearly 5-fold risk for developing dementia (HR 4.67 [1.82–12.01], p = 0.001) compared to controls of the same educational attainment.ConclusionsThere is a bi-directional association between epilepsy and dementia. with either condition carrying a nearly 2-fold risk of developing the other when compared to controls.

Lowering dementia risk and slowing progression of disease: the role of cognitive reserve and cognitive training

2020 ◽  
pp. 1-2 ◽  
Author(s):  
Jeffrey F. Scherrer ◽  
John E. Morley
Keyword(s):  
Educational Level ◽  
Cognitive Reserve ◽  
Leisure Activities ◽  
Inverse Correlation ◽  
Data Set ◽  
Dementia Risk ◽  
Dementia Incidence ◽  
Early Dementia ◽  
Progression Of Disease

Summary Almeida-Meza et al found an inverse correlation between cognitive reserve (associated with educational level, complexity of occupations and leisure activities) and dementia incidence. We suggest clarifying studies using their data-set and consider what can be done to modify socioeconomic inequalities that affect cognitive reserve or to slow early dementia.

P2277Utility of cardiovascular implantable electronic device (CIED)-derived patient activity, a novel digital biomarker, to predict inappropriate therapy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Rosero ◽  
P Jones ◽  
I Goldenberg ◽  
W Zareba ◽  
K Stein ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Electronic Device ◽  
Cox Proportional Hazards ◽  
Inappropriate Therapy ◽  
Activity Data ◽  
Proportional Hazards Regression ◽  
Kaplan Meier ◽  
Cardiovascular Implantable Electronic Device

Abstract Background The role of cardiovascular implantable electronic device (CIED)-derived activity to predict inappropriate implantable cardioverter-defibrillator (ICD) therapy is not known. The Multicenter Automatic Defibrillator Implantation Trial – Reduce Inappropriate Therapy (MADIT-RIT) enrolled 1500 patients with contemporary indication for an ICD or a CRT-D. We aimed to identify whether activity, as a digital biomarker, predicted inappropriate therapy. Methods In 1500 patients enrolled in MADIT-RIT, CIED-derived patient activity was acquired daily. CIED-derived activity was averaged for the first 30 days following randomization and utilized in this study to predict inappropriate therapy post- 30-day. Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression models were used to evaluate first inappropriate therapy by 30-day CIED-derived patient activity quintiles, and by 30-day device derived patient activity as a continuous measurement. Results There were a total of 1463 patients with activity data available (90%), 135 patients received at least one inappropriate therapy during the post-30 day follow-up period. Patients in the highest quintile (Q5) of CIED-derived activity (more active) were younger, more often males and more likely to have had a prior ablation of an atrial arrhythmia. Patients in the highest quintile of 30-day CIED-derived median activity had the highest risk of receiving inappropriate therapy, 21% at 2 years as compared 7–11% in the other four quintiles (Figure, p<0.001 for the overall duration). Patients with the highest level of 30-day median patient activity (Q5) had 1.75 times higher risk of any inappropriate therapy as compared with lower levels of activity, Q1-Q4 (HR=1.75, 95% CI: 1.23–2.50, p<0.002). Each 10% increase in CIED-derived 30-day median patient activity was associated with a significant, 73% increase in risk of receiving inappropriate therapy (HR=1.73, 95% CI: 1.17–2.54, p=0.005). Patients in the highest quintile for activity had a 68% increase in the risk of SVT excluding atrial fibrillation, atrial flutter or atrial tachycardia (HR=1.69, 95% CI: 1.26–2.25, p=0.004), despite 96% receiving beta-blocker medications. Inappropriate ICD Therapies by Activity Conclusions CIED-derived 30-day median patient activity predicted subsequent inappropriate therapy in ICD and CRT-D patients enrolled in MADIT-RIT. Patients with high levels of 30-day CIED-derived median patient activity were at a significantly higher risk of receiving inappropriate therapy. Activity, as a digital biomarker, may have utility in predicting and managing the risk of inappropriate therapy in this population. Acknowledgement/Funding Boston Scientific

scholarly journals 290. Impact of follow up blood cultures on outcomes of patients with gram-negative bloodstream infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S145-S145
Author(s):  
Rajiv G Amipara ◽  
Hana R Winders ◽  
Julie Ann Justo ◽  
P B Bookstaver ◽  
Joseph Kohn ◽  
...  
Keyword(s):  
South Carolina ◽  
Blood Culture ◽  
Proportional Hazards ◽  
Bloodstream Infections ◽  
Cox Proportional Hazards ◽  
Blood Cultures ◽  
Gram Negative ◽  
Source Of Infection

Abstract Background Importance of follow up blood cultures (FUBC) for Staphylococcus aureus bloodstream infections (BSI) is well known, but the role of FUBC in gram-negative BSI remains controversial. This retrospective cohort study examined the association between obtaining FUBC and mortality in patients with gram-negative BSI. Methods Adults with first episodes of community-onset monomicrobial BSI due to gram-negative bacilli hospitalized at Prisma Health-Midlands hospitals in Columbia, South Carolina, USA from January 1, 2010 to June 30, 2015 were identified. Patients who died or were discharged from hospital within 72 hours of collection of index blood culture were excluded to minimize impact of survival and selection biases on results, respectively. FUBC were defined as repeat blood cultures obtained between 24 and 96 hours from initial positive blood culture. Cox proportional hazards regression model was used to examine association between obtaining FUBC and 28-day all-cause mortality. Results Among 766 patients with gram-negative BSI, 219 (28.6%) had FUBC obtained and 15 of 219 (6.8%) FUBC were persistently positive. Overall, median age was 67 years, 438 (57%) were women, 457 (60%) had urinary source of infection, and 426 (56%) had BSI due to Escherichia coli. Mortality was significantly lower in patients who had FUBC obtained than in those who did not have FUBC (6.3% vs. 11.7%, log-rank p=0.03). Obtaining FUBC was independently associated with reduced mortality (hazards ratio [HR] 0.49, 95%CI: 0.25–0.90) after adjustments for age (HR 1.35 per decade, 95% CI: 1.13–1.61), cancer (HR 5.90, 95% CI: 3.53–9.84), Pitt bacteremia score (HR 1.38 per point, 95% CI: 1.26–1.50), and inappropriate empirical antimicrobial therapy (HR 2.37, 95% CI: 1.17–4.39). Conclusion Obtaining FUBC was associated with improved survival in hospitalized patients with gram-negative BSI. These observations are consistent with the results of recent publications from Italy and North Carolina supporting utilization of FUBC in the management of gram-negative BSI. Disclosures Julie Ann Justo, PharmD, MS, BCPS-AQ ID, bioMerieux (Speaker’s Bureau)TRC Healthcare (Speaker’s Bureau)

scholarly journals Breast Cancer Systemic Treatments and Upper Limb Lymphedema: A Risk-Assessment Platform Encompassing Tumor-Specific Pathological Features Reveals the Potential Role of Trastuzumab

2019 ◽  
Vol 8 (2) ◽  
pp. 138 ◽  
Author(s):  
Marco Invernizzi ◽  
Anna Michelotti ◽  
Marianna Noale ◽  
Gianluca Lopez ◽  
Letterio Runza ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Assessment ◽  
Proportional Hazards ◽  
Growth Factor Receptor ◽  
Cox Proportional Hazards ◽  
Breast Cancers ◽  
Pathological Features ◽  
Systemic Treatments

Breast cancer related lymphedema (BCRL) is frequent but strategies for an individualized risk assessment are lacking. We aimed to define whether tumor-specific pathological features, coupled with clinical and therapeutic data, could help identify patients at risk. Data from 368 patients with node-positive breast cancers were retrospectively collected, including 75 patients with BCRL (0.4–25.6 years follow-up). BCRL was assessed during the standard follow-up oncology visits using the circumferential measurement. Clinicopathologic and therapeutic factors associated with BCRL were integrated into a Cox proportional hazards regression model. Lymphovascular invasion (LVI) was more common in BCRL patients (n = 33, 44% vs. n = 85, 29%, p = 0.01), akin extra nodal extension (ENE) of the metastasis (n = 57, 76% vs. n = 180, 61%, p = 0.02). Sentinel lymph node excision without axillary dissection and extra-axillary radiotherapy were BCRL-unrelated. A higher number of BCRL-positive patients were treated with taxane-based chemotherapy with or without trastuzumab, compared to BCRL-negative patients (p < 0.01). Treatment with trastuzumab and/or taxanes, adjusted for systemic infections, laterality, therapy, and pathological features (i.e., LVI and ENE), had a significant impact in BCRL-free survival (p < 0.01). This work offers new insights on BCRL risk stratification, where the integration of clinical, therapeutic, and tumor-specific pathological data suggests a possible role of anti-human epidermal growth factor receptor 2 (HER2) therapy in BCRL pathogenesis.

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 Adjuvant Chemotherapy in Stage Ⅳ Hepatocellular Carcinoma Patients

2021 ◽  
Author(s):  
Quanhui Liao ◽  
Shaoxin Shen ◽  
Xijing Ma ◽  
Guisen Dai ◽  
Geng Lu ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Proportional Hazards ◽  
Stage Iv ◽  
Cox Proportional Hazards ◽  
Independent Factor ◽  
Cancer Specific Survival ◽  
Kaplan Meier ◽  
Prospective Trials

Abstract Background and objectives The purpose of the present study was to comprehensively analyze the prognostic value of adjuvant chemotherapy (CT) in stage IV HCC patients. Methods HCC patients were recognized in the Surveillance, Epidemiology and End Results (SEER) database. The effects of adjuvant CT on HCC patients were evaluated by Kaplan–Meier curves and multivariable Cox proportional hazards analyses. Results A total of 490 HCC patients were enrolled in this study and the median follow-up time was 2.69 months (range: 0–102 months). 34.3% (168) HCC patients received adjuvant CT, of which 58.6% (287) received local destruction, 25.5% (125) were partial resection and 15.9% (78) underwent liver transplantion. Multivariate analysis showed that chemotherapy (P <0.001), surgery (P <0.001), year at diagnosis (P = 0.004), grade (P <0.001) and fibrosis score (P = 0.039) were independent factor of cancer specific survival (CSS), and that chemotherapy (P <0.001), surgery (P <0.001), year at diagnosis (P = 0.005), grade (P <0.001) were independent factor of overall survival (OS). Survival curves confirmed that patients achieved an increased OS or CSS from adjuvant CT (P <0.05). Conclusions Our results concluded that compared to surgery alone, stage IV HCC patients could profit from adjuvant chemotherapy. High quality prospective trials are necessary to further confirm our results.

Role of PTEN in Gastrointestinal Stromal Tumor Progression

2004 ◽  
Vol 128 (4) ◽  
pp. 421-425
Author(s):  
Riccardo Ricci ◽  
Nicola Maggiano ◽  
Federica Castri ◽  
Alessandro Rinelli ◽  
Marino Murazio ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Univariate Analysis ◽  
Suppressor Gene ◽  
Cox Proportional Hazards ◽  
Rank Test ◽  
Mesenchymal Neoplasms ◽  
Immunohistochemical Assessment ◽  
Phosphatase And Tensin Homologue

Abstract Context.—Gastrointestinal stromal tumors (GISTs) are Kit/CD117-expressing mesenchymal neoplasms of uncertain malignant potential. The lack of a reliable method of prognostication hampers the selection of patients eligible for STI571 therapy. 10q22-q23 is a region involved in chromosomal losses found in a fraction of malignant primary and metastatic GISTs harboring PTEN (phosphatase and tensin homologue deleted on chromosome 10), a tumor suppressor gene often altered in human neoplasms. Objective.—To investigate the role of PTEN in GISTs, an issue that to our knowledge has not been addressed previously. Design.—PTEN status was determined in a series of 21 GISTs, with follow-up ranging between 6 and 198 months, using immunohistochemistry correlated with clinical data. Results.—A greater than 25% fraction of cells with low or absent PTEN immunostaining was detected in 9 GISTs, including all those showing malignancy. By the log-rank test, a fraction of PTEN-deficient cells greater than 25% was associated with malignancy (P &lt; .001). Percentage of cells underexpressing PTEN, size, cellularity, MIB-1 immunoreactivity, and coagulative necrosis proved to be associated with malignancy by Cox proportional hazards univariate analysis; low or absent expression of PTEN was the only factor selected by multivariate analysis (P = .03). Conclusions.—PTEN downregulation is implied in GIST progression. The immunohistochemical assessment of PTEN status appears to be a promising method of GIST prognostication.

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