scholarly journals 116Dementia risk in individuals with lifetime major trauma and post-traumatic stress disorder (PTSD) symptoms

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Dinuli Nilaweera
Keyword(s):  
Executive Function ◽  
Cognitive Function ◽  
Major Trauma ◽  
Later Life ◽  
Community Dwelling ◽  
Ptsd Symptoms ◽  
Consistent Finding ◽  
Dementia Risk ◽  
Incident Dementia ◽  
Lifetime Trauma

Abstract Background Increasing evidence suggests that stress may be a risk factor for dementia, however further investigation is required particularly in community-dwelling individuals. This study investigated whether lifetime major trauma with and without re-experiencing of PTSD symptoms is associated with dementia risk. Methods Participants were 1,700 community-dwelling men and women enrolled in the ESPRIT study of later-life neuropsychiatric disorders. Lifetime major trauma and PTSD were assessed using Watson’s PTSD Inventory. Cognitive function was measured using tests of global cognition, visual memory, verbal fluency, psychomotor speed and executive function. Fourteen-year incident dementia was diagnosed according to DSM-IV criteria. The association between lifetime trauma and cognition, as well as incident dementia was determined by multivariate logistic regression and Cox-proportional hazards regression, respectively. Results An unexpected, yet consistent finding was the association between lifetime major trauma without re-experiencing symptoms, and better baseline cognition (global OR: 0.67 [95% CI: 0.52-0.87], executive function OR: 0.69 [95% CI: 0.51-0.93]). Furthermore, lifetime trauma without re-experiencing symptoms was associated with a decreased risk of dementia (HR: 0.63, 95% CI: 0.44-0.91), particularly for females (HR: 0.49, 95% CI: 0.29-0.80). Conclusions Lifetime major trauma without re-experiencing symptoms may be protective for later-life cognitive function and could reduce dementia risk, especially in females. The mechanisms and moderating factors underlying these association requires further investigation. Key messages This study presents novel findings, and suggests that in some instances, experiencing traumatic events may be beneficial in later-life health.

Physical Performance Predictors for Incident Dementia Among Japanese Community-Dwelling Older Adults

2019 ◽  
Vol 99 (9) ◽  
pp. 1132-1140
Author(s):  
Takehiko Doi ◽  
Kota Tsutsumimoto ◽  
Sho Nakakubo ◽  
Min-Ji Kim ◽  
Satoshi Kurita ◽  
...  
Keyword(s):  
Older Adults ◽  
Risk Assessment ◽  
Grip Strength ◽  
Physical Performance ◽  
Performance Level ◽  
Community Dwelling ◽  
Sit To Stand ◽  
Dementia Risk ◽  
Incident Dementia ◽  
Community Dwelling Older Adults

Abstract Background Evaluating physical performance could facilitate dementia risk assessment. However, findings differ regarding which type of physical performance best predicts dementia. Objective The objective of this study was to examine the association between physical performance and incidence of dementia in Japanese community-dwelling older adults. Design This was a prospective study of community-dwelling older adults. Methods Of 14,313 invited individuals who were ≥ 65 years old, 5104 agreed to participate from 2011 to 2012, and 4086 (52% women; mean age = 72.0 years) met the criteria. Baseline assessments of the following physical performance indicators were obtained: grip strength, the Five-Times Sit-to-Stand Test, and the Timed “Up & Go” Test. The physical performance level in each test was categorized as C1 (highest), C2 (middle–high), C3 (middle–low), or C4 (lowest) on the basis of sex-stratified quartile values. Incident dementia status was obtained from medical records that were updated monthly. Results During follow-up (mean duration = 42.9 months), there were 243 incident cases of dementia (5.9%). Log-rank test results indicated that a lower physical performance level constituted a significant risk factor for dementia. After adjustment for covariates, Cox proportional hazards models (reference: highest physical performance level [C1]) demonstrated that the Five-Times Sit-to-Stand Test in the group with the lowest physical performance level (hazard ratio = 1.69; 95% CI = 1.10–2.59) was significantly associated with a risk of dementia. Likewise, the Timed “Up & Go” Test in the group with the lowest physical performance level (hazard ratio = 1.54; 95% CI = 1.01–2.35) was significantly associated with a risk of dementia. However, grip strength was not significantly associated with a risk of dementia. Limitations This study was limited by the use of medical record data. Conclusions A lower mobility-related physical performance level was associated with dementia risk. Dementia risk assessment should include an adequate evaluation of physical function.

scholarly journals SAT-LB115 Metformin-Use Is Associated With Slowed Cognitive Decline and Reduced Incident Dementia in Older Adults With Type 2 Diabetes Mellitus: The Sydney Memory and Ageing Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Katherine Samaras ◽  
Steve Makkar ◽  
John D Crawford ◽  
Nicole A Kochan ◽  
Wei Wen ◽  
...  
Keyword(s):  
Older Adults ◽  
Heart Disease ◽  
Executive Function ◽  
Older People ◽  
Cognitive Decline ◽  
Community Dwelling ◽  
Incident Dementia ◽  
Ageing Study ◽  
Global Cognition ◽  
Rate Of Decline

Abstract Background Metformin use in diabetes has been associated with both increased and decreased dementia rates in observational studies of people with diabetes. Objective: To examine changes in global cognition and specific cognitive domains over 6 years in older adults with diabetes treated with metformin, compared to other glucose lowering medications, and to people without diabetes. Methods Data were examined from the Sydney Memory and Ageing Study, a prospective observational study of 6 years duration of 1037 non-demented community-dwelling elderly aged 70-90 at baseline, derived from a compulsory electoral roll. Neuropsychological testing was performed every 2 years with domain measures of memory, executive function, language, visuospatial function, attention and processing speed and a composite of global cognition. Data were analysed by linear mixed modelling, including age, sex, education, body mass index, heart disease, diabetes, hypertension, stroke, smoking and apolipoprotein E ε4 carriage as covariates. Results: At baseline, 123 participants had diabetes (DM) with 67 receiving metformin (DM+MF) who were similar in demographics to those not receiving metformin (DM-noMF) and those without diabetes (no-DM). Participants with diabetes had higher BMI, lower HDL- and LDL-cholesterol and more prevalent heart disease, hypertension and smoking, compared to no-DM. Over 6-years, DM+MF participants had significantly slower rates of decline in global cognition and executive function, compared to DM-noMF, adjusted for covariates. The rate of decline for each cognitive domain was similar between DM+MF and controls. No impact was found in analyses examining interactions with sex, ApoEε4 carriage or hyperlipidemia. No difference was found in the rate of decline in brain volumes between the groups over 2 years. Incident dementia was significantly higher in DM-noMF, compared to DM+MF (adjusted OR 5.29 [95% CI 1.17-23.88], p,0.05), whereas risk of incident dementia was similar between DM+MF and participants without diabetes. Conclusions: In older people with diabetes receiving metformin, rates of cognitive decline and dementia were similar to that found in people without diabetes and significantly less than that found in people with diabetes not receiving metformin. Large randomized studies in people with and without diabetes are required to determine whether these associations can be attributed to metformin alone or if other factors explain these observations. Future studies will clarify if this cheap and safe medication can be repurposed for prevention of cognitive decline in older people.

scholarly journals Association of Angiotensin II–Stimulating Antihypertensive Use and Dementia Risk

Neurology ◽  
2020 ◽  
Vol 96 (1) ◽  
pp. e67-e80
Author(s):  
Jan Willem van Dalen ◽  
Zachary A. Marcum ◽  
Shelly L. Gray ◽  
Douglas Barthold ◽  
Eric P. Moll van Charante ◽  
...  
Keyword(s):  
Angiotensin Ii ◽  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Excess Mortality ◽  
Population Sample ◽  
Community Dwelling ◽  
Channel Blockers ◽  
Dementia Risk ◽  
Incident Dementia

ObjectiveTo assess whether angiotensin II–stimulating antihypertensives (thiazides, dihydropyridine calcium channel blockers, and angiotensin I receptor blockers) convey a lower risk of incident dementia compared to angiotensin II–inhibiting antihypertensives (angiotensin-converting enzyme inhibitors, β-blockers, and nondihydropyridine calcium channel blockers), in accordance with the “angiotensin hypothesis.”MethodsWe performed Cox regression analyses of incident dementia (or mortality as competing risk) during 6–8 years of follow-up in a population sample of 1,909 community-dwelling individuals (54% women) without dementia, aged 70–78 (mean 74.5 ± 2.5) years.ResultsAfter a median of 6.7 years of follow-up, dementia status was available for 1,870 (98%) and mortality for 1,904 (>99%) participants. Dementia incidence was 5.6% (27/480) in angiotensin II–stimulating, 8.2% (59/721) in angiotensin II–inhibiting, and 6.9% (46/669) in both antihypertensive type users. Adjusted for dementia risk factors including blood pressure and medical history, angiotensin II–stimulating antihypertensive users had a 45% lower incident dementia rate (hazard ratio [HR], 0.55; 95% CI, 0.34–0.89) without excess mortality (HR, 0.86; 95% CI, 0.64–1.16), and individuals using both types had a nonsignificant 20% lower dementia rate (HR, 0.80; 95% CI,0.53–1.20) without excess mortality (HR, 0.97; 95% CI, 0.76–1.24), compared to angiotensin II–inhibiting antihypertensive users. Results were consistent for subgroups based on diabetes and stroke history, but may be specific for individuals without a history of cardiovascular disease.ConclusionsUsers of angiotensin II–stimulating antihypertensives had lower dementia rates compared to angiotensin II–inhibiting antihypertensive users, supporting the angiotensin hypothesis. Confounding by indication must be examined further, although subanalyses suggest this did not influence results. If replicated, dementia prevention could become a compelling indication for older individuals receiving antihypertensive treatment.

scholarly journals Loneliness, Social Integration, and Incident Dementia Over 6 Years: Prospective Findings From the English Longitudinal Study of Ageing

2017 ◽  
Vol 75 (1) ◽  
pp. 114-124 ◽  
Author(s):  
Snorri Bjorn Rafnsson ◽  
Martin Orrell ◽  
Eleonora d’Orsi ◽  
Eef Hogervorst ◽  
Andrew Steptoe
Keyword(s):  
Longitudinal Study ◽  
Social Isolation ◽  
Close Relationships ◽  
Cox Regression ◽  
Later Life ◽  
Sensitivity Analyses ◽  
Reverse Causality ◽  
Dementia Risk ◽  
Incident Dementia ◽  
English Longitudinal Study

Abstract Objectives Social relationships are important for the maintenance of cognitive function at older ages, with both objective features of social networks and perceived social connections (loneliness) being relevant. There is limited evidence about how different aspects of social experience predict diagnosed dementia. Methods The sample comprised 6,677 dementia-free individuals at baseline (2004) from the English Longitudinal Study of Ageing. Baseline information on loneliness, number of close relationships, marital status, and social isolation (contact with family and friends and participation in organizations) was analyzed in relation to incident dementia over an average 6.25 years using Cox regression, controlling for potential confounding factors. Results Two hundred twenty participants developed dementia during follow-up. In multivariable analyses, dementia risk was positively related to greater loneliness (hazard ratio 1.40, 95% confidence interval 1.09–1.80, p = .008), and inversely associated with number of close relationships (p < .001) and being married (p = .018). Sensitivity analyses testing for reverse causality and different criteria for diagnosing dementia confirmed the robustness of these findings. There was no association with social isolation. Discussion Dementia risk is associated with loneliness and having fewer close relationships in later life. The underlying mechanisms remain to be elucidated, but efforts to enhance older peoples’ relationship quality may be relevant to dementia risk.

scholarly journals Homocysteine levels and dementia risk in Yoruba and African Americans

2013 ◽  
Vol 25 (11) ◽  
pp. 1859-1866 ◽  
Author(s):  
Hugh C. Hendrie ◽  
Olusegun Baiyewu ◽  
Kathleen A. Lane ◽  
Christianna Purnell ◽  
Sujuan Gao ◽  
...  
Keyword(s):  
African Americans ◽  
Vitamin B12 ◽  
Community Dwelling ◽  
Performance Category ◽  
Cognitively Normal ◽  
Significant Relationships ◽  
Dementia Risk ◽  
Incident Dementia ◽  
Increased Risk

ABSTRACTBackground:High levels of homocysteine have been associated with increased risk for dementia although results have been inconsistent. There are no reported studies from the developing world including Africa.Methods:In this longitudinal study of two community-dwelling cohorts of elderly Yoruba and African Americans, levels of homocysteine, vitamin B12 and folate were measured from blood samples taken in 2001. These levels were compared in two groups, participants who developed incident dementia in the follow-up until 2009 (59 Yoruba and 101 African Americans) and participants who were diagnosed as cognitively normal or in the good performance category at their last follow-up (760 Yoruba and 811 African Americans). Homocysteine levels were divided into quartiles for each site.Results:After adjusting for age, education, possession of ApoE, smoking, and time of enrollment the higher quartiles of homocysteine were associated with a non-significant increase in dementia risk in the Yoruba (homocysteine quartile 4 vs. 1 OR: 2.19, 95% CI 0.95–5.07, p = 0.066). For the African Americans, there was a similar but non-significant relationship between higher homocysteine levels and dementia risk. There were no significant relationships between levels of vitamin B12 and folate and incident dementia in either site although folate levels were lower and vitamin B12 levers were higher in the Yoruba than in the African Americans.Conclusions:Increased homocysteine levels were associated with a similar but non-significant increase in dementia risk for both Yoruba and African Americans despite significant differences in folate levels between the two sites.

scholarly journals Metformin-use is associated with slowed cognitive decline and reduced incident dementia in older adults with type 2 diabetes mellitus: the Sydney Memory and Ageing Study

2020 ◽  
Author(s):  
Katherine Samaras ◽  
Steve Makkar ◽  
John D. Crawford ◽  
Nicole A. Kochan ◽  
Wei Wen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Executive Function ◽  
Cognitive Decline ◽  
Dementia Risk ◽  
Incident Dementia ◽  
Ageing Study ◽  
Global Cognition

<b>Objective:</b> Type 2 diabetes mellitus (diabetes) is characterized by accelerated cognitive decline and higher dementia risk. Controversy exists regarding the impact of metformin which is associated with both increased and decreased dementia rates. The objective of this study was to determine the association of metformin-use with incident dementia and cognitive decline over 6 years in diabetes, compared to those not receiving metformin and those without diabetes. <p><b>Research</b> <b>Design and Methods</b>: Prospective observational study of N=1037 non-demented community-dwelling older participants aged 70-90 at baseline (the Sydney Memory and Ageing Study). Exclusion criteria were dementia, major neurological or psychiatric disease or progressive malignancy. Neuropsychological testing measured cognitive function every two years; a battery of tests measured executive function, memory, attention/speed, language and visuospatial function individually and to a construct of global cognition. Incident dementia was ascertained by a multidisciplinary panel. Total brain, hippocampal and parahippocampal volumes were measured by magnetic resonance at baseline and 2 years (n=526). Data were analyzed by linear mixed modeling, including the covariates of age, sex, education, body mass index, heart disease, hypertension, stroke, smoking and apolipoprotein Ee4 carriage. </p> <p><b>Results</b>: Of n=1037, 123 had diabetes; 67 received metformin (DM+MF) and were demographically similar to those not (DM-noMF) and participants without diabetes (no-DM). DM+MF had significantly slower global cognition and executive function decline compared to DM-noM. Incident dementia was significantly higher in DM-noMF compared to DM+MF (OR 5.29, 95%CI 1.17-23.88, p=0.05).</p> <p><b>Conclusions</b>: Older people with diabetes receiving metformin have slower cognitive decline and lower dementia risk. Large randomized studies in people with and without diabetes will determine whether these associations can be attributed to metformin. </p>

scholarly journals Links of Short Physical Performance Battery Score with Incident Dementia: Results from the NHATS

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 436-436
Author(s):  
Emily Smail ◽  
Jennifer Schrack ◽  
Amal Wanigatunga ◽  
Judith Kasper ◽  
Adam Spira ◽  
...  
Keyword(s):  
Physical Performance ◽  
Cox Regression ◽  
Later Life ◽  
Community Dwelling ◽  
Short Physical Performance Battery ◽  
Dementia Diagnosis ◽  
Incident Dementia ◽  
Lower Baseline ◽  
Nationally Representative ◽  
Prospective Association

Abstract Physical performance is associated with cognitive function in later life, but few studies have examined the prospective association of physical performance with incident dementia. We studied 4539 community-dwelling National Health and Aging Trends Study (NHATS) participants aged ≥65 years with data on demographics and the Short Physical Performance Battery (SPPB) in 2011, who were followed through 2014. Our outcome was dementia diagnosis from a validated NHATS algorithm. We applied survey weights to make results nationally representative and performed Cox regression analyses. After adjustment for potential confounders, lower baseline SPPB scores were associated with incident dementia (HR=1.68, p &lt; 0.01). Slower gait speed was the SPPB component most strongly associated with incident dementia (HR=1.21, p &lt; 0.01). We found that poorer physical performance was linked to incident dementia in a cohort of older adults. More research is needed to examine the effect of improving physical performance on the prevention of dementia.

The relationship between alcohol use and dementia: A combined analysis of prospective, individual-participant data from 15 international studies

2021 ◽  
Author(s):  
Louise Mewton ◽  
Rachel Visontay ◽  
Nicholas Hoy ◽  
Darren Lipnicki ◽  
John D Crawford ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Later Life ◽  
Community Dwelling ◽  
Competing Risk ◽  
Individual Participant Data ◽  
Risk Of Death ◽  
Dementia Risk ◽  
Individual Participant ◽  
The Relationship

Objective: To synthesise international findings on the alcohol-dementia relationship and provide a cross-national comparison of the alcohol-dementia relationship with critical evidence for the relationship between alcohol use and dementia in under-studied populations. Design and setting: Individual participant data meta-analysis of 15 prospective epidemiological cohort studies from countries situated in five continents. Cox regression investigated the dementia risk associated with alcohol use. Sensitivity analyses compared lifetime abstainers with former drinkers, adjusted extensively for demographic and clinical characteristics, and assessed the competing risk of death. Participants: 24,472 community-dwelling individuals without a history of dementia at baseline and at least one follow-up dementia assessment. Main outcome measure: All-cause dementia as determined by clinical interview. Results: During 151,574 person-years of follow-up, there were 2,137 incident cases of dementia (14.1 per 1,000 person-years). In the combined sample, when compared with occasional drinkers (&lt;1.3g/day), the risk for dementia was higher for current abstainers (HR: 1.29; 95% CI: 1.13, 1.48) and lower for moderate drinkers (25g/day-44.9g/day; HR: 0.79; 95% CI: 0.64, 0.98). When the combined sample was stratified by sex and gross domestic product, current abstainers had a greater risk of incident dementia when compared with light-to-moderate drinkers in both sexes and in the higher income countries. When comparing lifetime abstainers and former drinkers there were no consistent differences in dementia risk. Among current drinkers, there was no consistent evidence to suggest that the amount of alcohol consumed in later life was significantly associated with dementia risk. Adjusting for additional demographic and clinical covariates, and accounting for competing risk of death, did not substantially affect results. When analysed at the cohort level, there was considerable heterogeneity in the alcohol-dementia relationship. Conclusions: In a large and diverse international sample of older adults, the current study found that abstinence from alcohol is associated with an increased risk for all-cause dementia. Among current drinkers, there was no consistent evidence to suggest that the amount of alcohol consumed in later life was significantly associated with dementia risk.

scholarly journals Physical activity and trajectories in cognitive function: English Longitudinal Study of Ageing

2018 ◽  
Vol 72 (6) ◽  
pp. 477-483 ◽  
Author(s):  
Mark Hamer ◽  
Graciela Muniz Terrera ◽  
Panayotes Demakakos
Keyword(s):  
Physical Activity ◽  
Executive Function ◽  
Longitudinal Study ◽  
Cognitive Function ◽  
Reference Group ◽  
Repeated Measurements ◽  
Community Dwelling ◽  
Men And Women ◽  
English Longitudinal Study

BackgroundThere are limited data on physical activity in relation to trajectories in cognitive function. The aim was to examine the association of physical activity with trajectories in cognitive function, measured from repeated assessments over 10 years.MethodsWe conducted a 10-year follow-up of 10 652 (aged 65±10.1 years) men and women from the English Longitudinal Study of Ageing, a cohort of community dwelling older adults. Self-reported physical activity was assessed at baseline and neuropsychological tests of memory and executive function were administered at regular 2-year intervals. Data from six repeated measurements of memory over 10 years and five repeated measurements of executive function over 8 years were used.ResultsThe multivariable models revealed relatively small baseline differences in cognitive function by physical activity status in both men and women. Over the 10-year follow-up, physically inactive women experienced a greater decline in their memory (−0.20 recalled words, 95% CI −0.29 to −0.11, per study wave) and in executive function ability (−0.33 named animals; −0.54 to −0.13, per study wave) in comparison with the vigorously active reference group. In men, there were no differences in memory (−0.08 recalled words, 95% CI −0.18 to 0.01, per study wave), but small differences in executive function (−0.23 named animals; −0.46 to −0.01, per study wave) between inactive and vigorously active.ConclusionPhysical activity was associated with preservation of memory and executive function over 10 years follow-up. The results were, however, more pronounced in women.

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