Modifiable Risk Factors and Change in Cognition of Māori and Non-Māori in Advanced Age: LiLACS NZ

2021 ◽  
pp. 073346482199721
Author(s):  
Kristina Zawaly ◽  
Simon A. Moyes ◽  
Stephen Buetow ◽  
Lynette Tippett ◽  
Ngaire Kerse
Keyword(s):  
Risk Factors ◽  
New Zealand ◽  
Cognitive Change ◽  
Advanced Age ◽  
Repeated Measure ◽  
Modifiable Risk Factors ◽  
Mixed Effect ◽  
Dementia Risk ◽  
Modifiable Factors ◽  
Effect Regression

Objective: This study investigated whether previously identified modifiable risk factors for dementia were associated with cognitive change in Māori (indigenous people of New Zealand) and non-Māori octogenarians of LiLACS NZ (Life and Living in Advanced Age; a Cohort Study in New Zealand), a longitudinal study. Method: Multivariable repeated-measure mixed effect regression models were used to assess the association between modifiable risk factors and sociodemographic variables at baseline, and cognitive change over 6 years, with p values of <.05 regarded as statistically significant. Results: Modifiable factors associated with cognitive change differed between ethnic groups. Depression was a negative factor in Māori only, secondary education in non-Māori was protective, and obesity predicted better cognition over time for Māori. Diabetes was associated with decreased cognition for both Māori and non-Māori. Conclusion: Our results begin to address gaps in the literature and increase understanding of disparities in dementia risk by ethnicity. These findings have implications for evaluating the type and application of culturally appropriate methods to improve cognition.

scholarly journals Dietary intake and prospective changes in cardiometabolic risk factors in children and youth

2017 ◽  
Vol 42 (1) ◽  
pp. 39-45 ◽  
Author(s):  
Solmaz Setayeshgar ◽  
John Paul Ekwaru ◽  
Katerina Maximova ◽  
Sumit R. Majumdar ◽  
Kate E. Storey ◽  
...  
Keyword(s):  
Risk Factors ◽  
Dietary Intake ◽  
Dietary Fat ◽  
Sodium Intake ◽  
Children And Youth ◽  
Excess Body Weight ◽  
Mixed Effect ◽  
Sensitivity Score ◽  
Effect Regression

Only few studies examined the effect of diet on prospective changes in cardiometabolic (CM) risk factors in children and youth despite its importance for understanding the role of diet early in life for cardiovascular disease in adulthood. To test the hypothesis that dietary intake is associated with prospective changes in CM risk factors, we analyzed longitudinal observations made over a period of 2 years among 448 students (aged 10–17 years) from 14 schools in Canada. We applied mixed effect regression to examine the associations of dietary intake at baseline with changes in body mass index, waist circumference (WC), systolic and diastolic blood pressure (SBP and DBP), and insulin sensitivity score between baseline and follow-up while adjusting for age, sex, and physical activity. Dietary fat at baseline was associated with increases in SBP and DBP z scores (per 10 g increase in dietary fat per day: β = 0.03; p < 0.05) and WC (β = 0.31 cm; p < 0.05) between baseline and follow-up. Every additional gram of sodium intake at baseline was associated with an increase in DBP z score of 0.04 (p < 0.05) between baseline and follow-up. Intake of sugar, vegetables and fruit, and fibre were not associated with changes in CM risk factors in a statistically significant manner. Our findings suggest that a reduction in the consumption of total dietary fat and sodium may contribute to the prevention of excess body weight and hypertension in children and youth, and their cardiometabolic sequelae later in life.

scholarly journals What do young Australian adults know about modifiable risk factors for dementia?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hannah A. D. Keage ◽  
Gabrielle Villani ◽  
Amanda D. Hutchinson
Keyword(s):  
Risk Factors ◽  
Social Media ◽  
Young Adults ◽  
Hearing Loss ◽  
Functional Impairment ◽  
Early Life ◽  
Online Survey ◽  
Modifiable Risk Factors ◽  
Dementia Risk ◽  
Social Media Platforms

Abstract Background There are well established modifiable risk factors for late-life dementia. These risk factors account for over 30% of population attributable dementia risk and accrue over the lifespan. Young adults have the greatest potential to reduce their own risk for dementia. This study aimed to investigate what young Australian adults know about dementia and its risk factors, and further, how they estimated these risks. Methods An online survey promoted through various social media platforms was completed by 604 young Australian adults aged 18–44 years of age. Results Seventy percent of participants had a limited understanding of dementia (identifying cognitive or functional impairment), 25% had a good understanding, with 5% having no understanding. Twenty percent of respondents thought there were no modifiable risk factors for dementia. Less the half of participants agreed with two of the nine established dementia risk factors (hearing loss in midlife and education in early life), with over half of participants agreeing to the remaining seven risk factors. Females consistently judged the risks conferred by the nine established dementia risk factors to be higher than males. Those who were lonely judged the dementia risk conferred by loneliness to be higher than those who were not lonely; and smokers judged the dementia risk conferred by smoking to be less than non-smokers. Conclusion Young adults have the greatest potential to change their dementia risk, and these findings show that there are important gaps in knowledge of dementia and its risk factors in this group.

scholarly journals Modifiable Risk Factors for Incident Dementia and Cognitive Impairment: An Umbrella Review of Evidence

2021 ◽  
Author(s):  
Yaru Zhang ◽  
Wei Xu ◽  
Wei Zhang ◽  
Hui-Fu Wang ◽  
Ya-Nan Ou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Systematic Reviews ◽  
Plasma Glucose ◽  
Prospective Studies ◽  
Mendelian Randomization ◽  
Convincing Evidence ◽  
Modifiable Risk Factors ◽  
Umbrella Review ◽  
Modifiable Factors

Abstract Dementia and cognitive impairment can be attributed to both genetic and modifiable risk factors. Recently, considerable evidence emerged and urgently require standardized evaluation. To address it, we conducted an umbrella review of prospective studies regarding the associations of dementia and cognitive impairment with modifiable factors to evaluate the strength and validity of the existing evidence. We searched PubMed, Embase, CINAHL and Cochrane Database of Systematic Reviews to identify relevant systematic reviews and meta-analyses of prospective studies. Mendelian randomization studies were reviewed to assess the causality for these associations. For each association, we analyzed the summary effect size, 95% confidence interval, 95% prediction interval, heterogeneity, small study effect and excess significance bias. Based on these estimates, the evidence was graded into levels of convincing, highly suggestive, suggestive, or weak. In total, 12015 articles were identified, of which 118 eligible studies yielded 243 unique associations. Convincing evidence was found for associations of dementia and cognitive impairment with early-life education, midlife to late-life plasma glucose, body mass index, atrial fibrillation, benzodiazepine use, and gait speed. Suggestive to highly suggestive evidence was found for associations of dementia and cognitive impairment with midlife to late-life blood pressure, homocysteine, cerebrovascular diseases, hearing impairment, respiratory illness, anemia, smoking, alcohol consumption, diet, sleep, physical activity and social engagement. Among convincing evidence, Mendelian randomization studies verified genetic predicted causal relationships for education and plasma glucose with Alzheimer's disease. Modifiable factors identified in this study, especially those with high-level evidence, should be considered in dementia prevention. Trial registration: PROSPERO CRD42020195729.

scholarly journals Modifiable risk factors for homebound progression among those with and without dementia in a longitudinal survey of community-dwelling older adults

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mia Yang ◽  
Nicholas Pajewski ◽  
Mark Espeland ◽  
Douglas Easterling ◽  
Jeff D. Williamson
Keyword(s):  
Risk Factors ◽  
Depressive Symptoms ◽  
Proportional Hazards ◽  
Clinical Care ◽  
Community Dwelling ◽  
Modifiable Risk Factors ◽  
Mobility Impairment ◽  
Annual Survey ◽  
Increased Risk ◽  
Modifiable Factors

Abstract Background Being homebound is independently associated with increased mortality but the homebound population is heterogeneous. In order to improve precision medicine, we analyzed potentially modifiable factors that contribute to homebound progression (from independent to needing assistance, to homebound), stratified by dementia status. Methods Using National Aging and Trends Survey (NHATS), a nationally-representative, longitudinal annual survey from 2011 to 2017 (n = 11,528), we categorized homebound progression if one transitioned from independent or needing assistance to homebound, including competing risks of institutionalization or death between 2011 and last year of data available for each unique respondent. Using proportional hazards regression, we calculated hazard ratios of potentially modifiable risk factors on homebound progression. Results Depressive symptoms, mobility impairment, and pain increased risk of homebound progression regardless of dementia status. Social isolation increased risk of homebound progression only among those without dementia at baseline. Conclusion Future clinical care and research should focus on the treatment of depressive symptoms, mobility, and pain to potentially delay progression to homebound status.

scholarly journals The Effect of Sex and Wealth on Population Attributable Risk Factors for Dementia in South Africa

2021 ◽  
Vol 12 ◽  
Author(s):  
Kirsten Bobrow ◽  
Tina Hoang ◽  
Deborah E. Barnes ◽  
Raquel C. Gardner ◽  
Isabel E. Allen ◽  
...  
Keyword(s):  
Risk Factors ◽  
South Africa ◽  
Risk Factor ◽  
Social Determinants Of Health ◽  
Social Isolation ◽  
Social Determinants ◽  
Physical Inactivity ◽  
Modifiable Risk Factors ◽  
Dementia Risk ◽  
Low Education

Background and Aims: South Africa is a middle-income country with high levels of income inequality and a rapidly aging population and increasing dementia prevalence. Little is known about which risk factors for dementia are important and how they differ by social determinants of health as well as key demographic characteristics such as sex and wealth. We sought to calculate the population attributable risks (PARs) for established potentially modifiable risk factors for dementia among these different groups.Methods: We obtained risk factor prevalence from population-based surveys for established dementia risk factors (diabetes, midlife hypertension, midlife obesity, physical inactivity, depression, smoking, low educational attainment, social isolation). We used relative risk estimates reported in previous meta-analyses and estimated PARs using Levin's formula and accounting for communality. We tested for one-way and two-way interactions by sex and wealth using Pearson's χ2. In stratified analyses, we performed tests for trend using logistic regression.Results: The prevalence of established risk factors for dementia ranged from 5% for depression to 64% for low education. After accounting for communality, the risk factors contributing the greatest PAR were low education (weighted PAR 12%, 95% CI 7% to 18%), physical inactivity (9, 5–14%), and midlife hypertension (6, 5–14%). Together, 45% of dementia cases may be attributable to modifiable risk factors (95% CI 25–59%). We found significant interactions (p &lt; 0.005) between sex, wealth, or both (sex * wealth) and each risk factor except social isolation and physical activity. Low education was inversely associated with wealth in both male and female. The PAR for midlife hypertension, obesity, and diabetes was associated with increasing wealth, and was higher in female. In contrast, the PAR for smoking was higher in male (8% vs. 2%) and was associated with increasing wealth among female only. We found that either a strategy of large reductions in selected risk factors with the highest PAR (midlife hypertension, smoking, physical inactivity) or small reductions across all risk factors could potentially reduce dementia cases by as many as 250,000 by 2050.Discussions: The potential impact on dementia risk by decreasing exposure to established dementia risk factors is large and differs by sex and social determinants of health like wealth. Risk factor PAR should inform national and local health policy dementia initiatives in South Africa including which risk factors to target in the whole population and which to target in high-risk groups for maximum public health benefit.

Antidiabetic therapies and Alzheimer disease

2019 ◽  
Vol 21 (1) ◽  
pp. 83-91 ◽  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Alzheimer Disease ◽  
Modifiable Risk Factors ◽  
Cardiovascular Risks ◽  
Increased Risk ◽  
Modifiable Factors ◽  
Diet And Physical Activity ◽  
Substantial Interest

Given current lack of therapies for dementia, there is substantial interest in identifying potentially modifiable risk factors. Clarifying the potential of these factors to mitigate risk as well as determining the mechanisms that link these factors to dementia is expected to lead to new approaches for both preventing and treating neurodegenerative diseases such as Alzheimer disease. Modifiable factors include cardiovascular risks as well as related lifestyle-centric factors such as diet and physical activity (reviewed in this issue). Given reports that type 2 diabetes and associated features increase the risk for developing dementia, there has been tremendous interest in exploring whether use of antidiabetic medications may impact the risk of dementia, as well as whether antidiabetic medications could be used to prevent or treat dementia, particularly Alzheimer disease. This review will briefly cover the known links between diabetes and risk for dementia, the state of evidence linking antidiabetic treatments with either protection against dementia or possibly increased risk for cognitive dysfunction, and provide a brief overview of what has been learned from clinical trials testing antidiabetic treatments in Alzheimer disease.

scholarly journals Central line-associated bloodstream infections in Australian ICUs: evaluating modifiable and non-modifiable risks in Victorian healthcare facilities

2017 ◽  
Vol 145 (14) ◽  
pp. 3047-3055 ◽  
Author(s):  
T. SPELMAN ◽  
D. V. PILCHER ◽  
A. C. CHENG ◽  
A. L. BULL ◽  
M. J. RICHARDS ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Ultrasound Guidance ◽  
Bloodstream Infections ◽  
Central Line ◽  
Modifiable Risk Factors ◽  
Full Time ◽  
Healthcare Associated Infection ◽  
Factors Associated ◽  
Modifiable Factors

SUMMARYCentral line-associated bloodstream infections (CLABSIs) in intensive care units (ICUs) result in poor clinical outcomes and increased costs. Although frequently regarded as preventable, infection risk may be influenced by non-modifiable factors. The objectives of this study were to evaluate organisational factors associated with CLABSI in Victorian ICUs to determine the nature and relative contribution of modifiable and non-modifiable risk factors. Data captured by the Australian and New Zealand Intensive Care Society regarding ICU-admitted patients and resources were linked to CLABSI surveillance data collated by the Victorian Healthcare Associated Infection Surveillance System between 1 January 2010 and 31 December 2013. Accepted CLABSI surveillance methods were applied and hospital/patient characteristics were classified as ‘modifiable’ and ‘non-modifiable’, enabling longitudinal Poisson regression modelling of CLABSI risk. In total, 26 ICUs were studied. Annual CLABSI rates were 1·72, 1·37, 1·00 and 0·93/1000 CVC days for 2010–2013. Of non-modifiable factors, the number of non-invasively ventilated patients standardised to total ICU bed days was found to be independently associated with infection (RR 1·07; 95% CI 1·01–1·13; P = 0·030). Modelling of modifiable risk factors demonstrated the existence of a policy for mandatory ultrasound guidance for central venous catheter (CVC) localisation (RR 0·51; 95% CI 0·37–0·70; P < 0·001) and increased number of sessional specialist full-time equivalents (RR 0·52; 95% CI 0·29–0·93; P = 0·027) to be independently associated with protection against infection. Modifiable factors associated with reduced CLABSI risk include ultrasound guidance for CVC localisation and increased availability of sessional medical specialists.

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