Subjective cognitive decline and subsequent dementia: a nationwide cohort study of 579,710 people aged 66 years in South Korea

Abstract Background Subjective cognitive decline (SCD) is a potential risk factor for dementia. We aimed to investigate the association between SCD and subsequent dementia in a nationwide population-based cohort in South Korea. Methods This cohort included 579,710 66-year-old adults who were followed for a total of 3,870,293 person-years (average 6.68±1.33 years per person). All subjects completed a questionnaire about subjective memory impairment, the Pre-screening Korean Dementia Screening Questionnaire (KDSQ-P), which included a validated 5-item derivative, and were determined to have SCD based on a single question assessing memory decline. Depressive symptoms were assessed in all subjects using a 3-item modified geriatric depression scale. Hazard ratios were estimated using the Cox proportional hazards model and compared between subjects with and without SCD. Results Compared to subjects without SCD, those with SCD were more likely to develop dementia (incidence per 1,000 person-years: non-SCD: 5.66; SCD: 8.59). After adjusting for potential confounding factors, the risk of subsequent dementia significantly increased in subjects with SCD, with an adjusted hazard ratio (aHR) of 1.38 (95% confidence interval [CI] 1.34 to 1.41). The risk of subsequent dementia was greatly increased in subjects with higher KDSQ-P scores (aHR = 2.77, 95% CI 2.47 to 3.11). A significant association between SCD and dementia was observed in both depressive and non-depressive symptom groups (aHR = 1.50, 95% CI 1.42 to 1.57 in subjects with depressive symptoms; aHR = 1.33, 95% CI 1.29 to 1.37 in subjects without depressive symptoms; P = 0.001). Conclusions In this population of 66-year-old individuals, SCD was significantly associated with an increased risk of subsequent dementia. This association was found in both depressive and non-depressive groups, with an increased risk of dementia in the presence of depressive symptoms. Our findings suggest that SCD indicates a risk for dementia. Further studies are needed to delineate potential approaches to preventing the development of dementia in individuals with SCD.

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Subjective cognitive decline and subsequent dementia: a nationwide cohort study of 579,710 people (66 year-olds) in South Korea

10.21203/rs.2.19062/v1 ◽

2019 ◽

Author(s):

Yeong Chan Lee ◽

Jae Myeong Kang ◽

Hyewon Lee ◽

Kiwon Kim ◽

Soyeon Kim ◽

...

Keyword(s):

Depressive Symptoms ◽

South Korea ◽

Cognitive Decline ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Population Based ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Subjective Cognitive Decline ◽

Increased Risk

Abstract Background: Subjective cognitive decline (SCD) is a potential risk factor for dementia. We aimed to investigate the association between SCD and subsequent dementia in a nationwide population-based cohort in South Korea.Methods: This cohort included 579,710 66-year-old adults who completed a questionnaire about SCD and were followed-up for a total of 3,870,293 person-years (average 6.68 years per person). Hazard ratios were estimated using the Cox proportional hazards model and compared between subjects with and without SCD.Results: Compared to subjects without SCD, those with SCD were more likely to develop dementia (incidence per 100,000 person-years: no SCD: 566.14; SCD: 859.35). After adjusting for potential confounding factors, the risk of subsequent dementia significantly increased in subjects with SCD, with an adjusted hazard ratio (aHR) of 1.38 (95% confidence interval [CI] 1.34 to 1.41). The risk of subsequent dementia was greatly increased in subjects with higher SCD scores (aHR=2.77, 95% CI 2.47 to 3.11). A significant association between SCD and dementia was observed in both depressive and non-depressive symptom groups (aHR=1.50, 95% CI 1.42 to 1.57 in subjects with depressive symptoms; aHR=1.33, 95% CI 1.29 to 1.37 in subjects without depressive symptoms; P =0.001).Conclusions: In the participating 66-year-old population, SCD was significantly associated with an increased risk of subsequent dementia, independent of the presence of depressive symptoms. Our findings suggest that SCD indicates a risk for dementia. Further studies are needed to delineate potential approaches to preventing the development of dementia in individuals with SCD.

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Effect of Physical Comorbidities on Risk of Depression in Multiple Sclerosis

International Journal of MS Care ◽

10.7224/1537-2073-11.4.161 ◽

2009 ◽

Vol 11 (4) ◽

pp. 161-165 ◽

Cited By ~ 3

Author(s):

Ruth Ann Marrie ◽

Gary Cutter ◽

Tuula Tyry ◽

Denise Campagnolo ◽

Timothy Vollmer

Keyword(s):

Multiple Sclerosis ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Depression Scale ◽

Epidemiologic Studies ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Research Committee ◽

The North ◽

Increased Risk

Depression in multiple sclerosis (MS) may be due to several factors, including the presence of physical comorbidities. Using the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry, we examined whether individuals with MS and physical comorbidities have an increased risk of depression compared with those without physical comorbidities and whether they are more likely to remain untreated for depression. In 2006, NARCOMS participants reported their physical and mental comorbidities and completed the Center for Epidemiologic Studies Depression Scale (CESD). We defined a CESD score of 21 or higher as indicating probable major depression. Individuals with elevated CESD scores but no diagnosis of depression were considered undiagnosed. Forty-six percent of participants reported a lifetime history of depression. In a multivariable Cox proportional hazards model, reporting any physical comorbidity was associated with an increased risk of being diagnosed with depression (hazard ratio [HR], 2.20; 95% confidence interval [CI], 2.04–2.38) after MS onset and with an increased risk of diagnosed or undiagnosed depression (HR, 2.37; 95% CI, 2.21–2.54). After adjustment for education, participants with any physical comorbidity were more likely to report treatment for depression (odds ratio [OR], 1.67; 95% CI, 1.24–2.23). Patients with MS and physical comorbidities are at increased risk of depression, but they are more likely to be diagnosed and treated than MS patients without other chronic conditions.

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Elevated plasma growth and differentiation factor 15 predicts incident anemia in older adults aged 60 years and older

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa324 ◽

2020 ◽

Author(s):

Yuko Yamaguchi ◽

Marta Zampino ◽

Toshiko Tanaka ◽

Stefania Bandinelli ◽

Yusuke Osawa ◽

...

Keyword(s):

Older Adults ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Differentiation Factor ◽

Hazards Model ◽

Increased Risk ◽

The Relationship

Abstract Background Anemia is common in older adults and associated with greater morbidity and mortality. The causes of anemia in older adults have not been completely characterized. Although elevated circulating growth and differentiation factor 15 (GDF-15) has been associated with anemia in older adults, it is not known whether elevated GDF-15 predicts the development of anemia. Methods We examined the relationship between plasma GDF-15 concentrations at baseline in 708 non-anemic adults, aged 60 years and older, with incident anemia during 15 years of follow-up among participants in the Invecchiare in Chianti (InCHIANTI) Study. Results During follow-up, 179 (25.3%) participants developed anemia. The proportion of participants who developed anemia from the lowest to highest quartile of plasma GDF-15 was 12.9%, 20.1%, 21.2%, and 45.8%, respectively. Adults in the highest quartile of plasma GDF-15 had an increased risk of developing anemia (Hazards Ratio 1.15, 95% Confidence Interval 1.09, 1.21, P<.0001) compared to those in the lower three quartiles in a multivariable Cox proportional hazards model adjusting for age, sex, serum iron, soluble transferrin receptor, ferritin, vitamin B12, congestive heart failure, diabetes mellitus, and cancer. Conclusions Circulating GDF-15 is an independent predictor for the development of anemia in older adults.

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Blood eosinophils on hospital admission for COPD exacerbation do not predict the recurrence of moderate and severe relapses

ERJ Open Research ◽

10.1183/23120541.00543-2020 ◽

2021 ◽

Vol 7 (1) ◽

pp. 00543-2020

Author(s):

Balázs Csoma ◽

András Bikov ◽

Ferenc Tóth ◽

György Losonczy ◽

Veronika Müller ◽

...

Keyword(s):

Proportional Hazards ◽

Proportional Hazards Model ◽

Forced Expiratory Volume ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Full Blood Count ◽

Rank Test ◽

Severe Exacerbation ◽

Increased Risk ◽

Exacerbation Of Copd

Background and objectiveThe relationship between hospitalisation with an eosinophilic acute exacerbation of COPD (AE-COPD) and future relapses is unclear. We aimed to explore this association by following 152 patients for 12 months after hospital discharge or until their first moderate or severe flare-up.MethodsPatients hospitalised with AE-COPD were divided into eosinophilic and non-eosinophilic groups based on full blood count results on admission. All patients were treated with a course of systemic corticosteroid. The Cox proportional hazards model was used to study the association with the time to first re-exacerbation; a generalised linear regression model was applied to identify clinical variables related to the recurrence of relapses.ResultsWe did not find a difference in the time to the next moderate or severe exacerbation between the eosinophilic (≥2% of total leukocytes and/or ≥200 eosinophils·µL−1, n=51, median (interquartile range): 21 (10–36) weeks) and non-eosinophilic groups (n=101, 17 (9–36) weeks, log-rank test: p=0.63). No association was found when other cut-off values (≥3% of total leukocytes and/or ≥300 eosinophils·µL−1) were used for the eosinophilic phenotype. However, the higher number of past severe exacerbations, a lower forced expiratory volume in 1 s (FEV1) at discharge and higher pack-years were related to shorter exacerbation-free time. According to a subgroup analysis (n=73), 48.1% of patients with initial eosinophilic exacerbations had non-eosinophilic relapses on readmission.ConclusionsOur data do not support an increased risk of earlier recurring moderate or severe relapses in patients hospitalised with eosinophilic exacerbations of COPD. Eosinophilic severe exacerbations present a variable phenotype.

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Abstract MP60: Depressive Symptoms and Risk of Incident Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis

Circulation ◽

10.1161/circ.137.suppl_1.mp60 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Parveen K Garg ◽

Wesley T O'Neal ◽

Ana V Diez Roux ◽

Alvaro Alonso ◽

Elsayed Soliman ◽

...

Keyword(s):

Atrial Fibrillation ◽

Depressive Symptoms ◽

Proportional Hazards ◽

Depression Scale ◽

Epidemiologic Studies ◽

Cox Proportional Hazards ◽

Fee For Service ◽

Score Distribution ◽

Ethnic Study ◽

Increased Risk

Background: Depression has been suggested as a potential risk factor for atrial fibrillation (AF) through effects on the autonomic nervous system and hypothalamus-pituitary-adrenal axis. Current literature examining the prospective relationship between depression and AF is inconsistent and limited to studies performed in predominantly white populations. We determined the relationship of both depressive symptoms and anti-depressant use with incident AF in a multi-ethnic cohort. Methods: The Multi-Ethnic Study of Atherosclerosis is a prospective study of 6,814 individuals without clinical cardiovascular disease. Depressive symptoms were assessed at baseline by the 20-item Center for Epidemiologic Studies Depression Scale (CES-D) and use of anti-depressant medications. Five CES-D groups were created based on the score distribution in approximate quartiles, and the top quartile split in 2 such that the top group represented persons with a score ≥16, a value commonly used to identify clinically relevant symptoms. Incident AF was identified from study ECGs verified for AF, ICD-9 hospital discharge diagnoses consistent with AF, and, for participants enrolled in fee-for-service Medicare, inpatient and outpatient AF claims data. Results: 6,644 participants (mean age=62; 53% women; 38% white; 28% black; 22% Hispanic; 12% Chinese-American) were included and followed for a median of 13 years. In separate adjusted Cox proportional hazards analyses, a CES-D≥16 (referent=CES-D<2) and anti-depressant use were each associated with higher incidence of AF (Table). Associations did not differ by race or gender (interaction p-values of 0.18 and 0.17 respectively). Similar results were obtained using time-updated measures of depression. Conclusions: Depressive symptoms are associated with an increased risk of incident AF. Further study into whether improving depressive symptoms reduces AF incidence is important.

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Abstract WP79: Choice Of Treatment And Effect On Hemorrhage Rates Of Unruptured Intracranial Aneurysms

Stroke ◽

10.1161/str.44.suppl_1.awp79 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

James Torner ◽

Jie Zhang ◽

David Piepgras ◽

John Huston ◽

Irene Meissner ◽

...

Keyword(s):

Intracranial Aneurysms ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Interventional Procedure ◽

Careful Consideration ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Unruptured Intracranial Aneurysms ◽

Increased Risk

INTRODUCTION: The decision regarding whether to perform an interventional procedure as a strategy to prevent hemorrhage of an unruptured intracranial aneurysm (UIA) requires careful consideration of procedural risk and the UIA natural history. No randomized trial data are available. The International Study of Unruptured Intracranial Aneurysms (ISUIA) included a prospective cohort, examining hemorrhage risk and treatment risk. Hypothesis: The purpose of this analysis was to compare the factors related to treatment selection and determination of the number of hemorrhages prevented. Methods: Patients were allocated into the initial treatment and untreated cohorts based upon observation or treatment practices in 61 centers from 1991-1998. 1691 patients were in the observational cohort, 471 were in the endovascular cohort and 1917 patients were in the surgical cohort. The cohorts were followed for a median follow-up of 9.2 years. Outcomes were determined prospectively and with central review. The data were grouped together and analyzed to determine treatment decisions. A Cox proportional hazards model predicting hemorrhage developed in the observation cohort and was applied to the surgery and endovascular cohorts across the follow-up period. Results: Significant baseline variable differences between treated and observed patients were aneurysm size, symptoms, age, prior SAH group, geographical region, treatment percentage, aneurysm daughter sacs or multiple lobes, and history of hypertension, smoking and myocardial infarction. Aneurysm site and family history were not significant. Site, size, and aspirin use were significant predictors of hemorrhage. Long-term the predicted hemorrhage rates were 6.7% at 5 years and 8.0% at 10 years in the surgery group and 8.1% and 9.6% for the endovascular group, respectively. For comparison the rates in the observed cohort were 4.1% and 4.8%, respectively. Conclusions: Decisions for treatment are influenced by patient characteristics such as age and medical history, aneurysm characteristics such as size and morphology and center and regional practices. Patients in the treated cohorts were at moderately increased risk for hemorrhage compared to those in the observed cohort.

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Associations of Endometriosis and Hormone Therapy With Risk of Hyperlipidemia

American Journal of Epidemiology ◽

10.1093/aje/kwaa173 ◽

2020 ◽

Author(s):

Cherry Yin-Yi Chang ◽

Chih-Hsin Muo ◽

Yi-Chun Yeh ◽

Chung-Yen Lu ◽

William Wu-Chou Lin ◽

...

Keyword(s):

Hormone Therapy ◽

Structural Model ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Marginal Structural Model ◽

Bilateral Oophorectomy ◽

Hazards Model ◽

Increased Risk

Abstract Using claims data from the universal health insurance program of Taiwan, we conducted a retrospective cohort study to investigate whether endometriosis and hormone therapy are associated with the risk of developing hyperlipidemia. We selected 9,155 women aged 20–55 years with endometriosis diagnosed during the period 2000–2013 and 212,641 women without endometriosis with a median follow-up time of 7 years. Among patients with endometriosis, 86% of cases were identified on the basis of diagnosis codes with an ultrasound claim, and 14% were defined by diagnostic laparoscopy or surgical treatments. In a Cox proportional hazards model, the adjusted hazard ratio was 1.30 (95% confidence interval (CI): 1.19, 1.41) for all women, 1.04 (95% CI: 0.81, 1.32) for women under 35 years of age, 1.17 (95% CI: 1.03, 1.32) for women aged 35–44 years, and 1.34 (95% CI: 1.18, 1.52) for women aged 45–54 years. Hysterectomy and/or bilateral oophorectomy accounted for 46.9% of the association between endometriosis and hyperlipidemia, and hormone therapy accounted for 21.6%. Among women with endometriosis, the marginal structural model approach adjusting for time-varying hysterectomy/bilateral oophorectomy showed no association between use of hormone medications and risk of hyperlipidemia. We concluded that women with endometriosis are at increased risk of hyperlipidemia; use of hormone therapy by these women was not independently associated with the development of hyperlipidemia.

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Predictive Value of First Posttreatment Imaging Using Standardized Reporting in Head and Neck Cancer

Otolaryngology ◽

10.1177/0194599819865235 ◽

2019 ◽

Vol 161 (6) ◽

pp. 978-985 ◽

Cited By ~ 8

Author(s):

Derek Hsu ◽

Falgun H. Chokshi ◽

Patricia A. Hudgins ◽

Suprateek Kundu ◽

Jonathan J. Beitler ◽

...

Keyword(s):

Treatment Failure ◽

Head And Neck ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Strong Association ◽

Treatment Completion ◽

Tertiary Hospital ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Increased Risk

Objective The Neck Imaging Reporting and Data System (NI-RADS) is a standardized numerical reporting template for surveillance of head and neck squamous cell carcinoma (HNSCC). Our aim was to analyze the accuracy of NI-RADS on the first posttreatment fluorodeoxyglucose positron emission tomography/contrast-enhanced computed tomography (PET/CECT). Study Design Retrospective cohort study. Setting Academic tertiary hospital. Subject and Methods Patients with HNSCC with a 12-week posttreatment PET/CECT interpreted using the NI-RADS template and 9 months of clinical and radiologic follow-up starting from treatment completion between June 2014 and July 2016 were included. Treatment failure was defined as positive tumor confirmed by biopsy or Response Evaluation Criteria in Solid Tumors criteria. Cox proportional hazards models were performed. Results This study comprised 199 patients followed for a median of 15.5 months after treatment completion (25% quartile, 11.8 months; 75% quartile, 20.2 months). The rates of treatment failure increased with each incremental increase in NI-RADS category from 1 to 3 (4.3%, 9.1%, and 42.1%, respectively). A Cox proportional hazards model demonstrated a strong association between NI-RADS categories and treatment failure at both primary and neck sites (hazard ratio [HR], 2.60 and 5.22, respectively; P < .001). In the smaller treatment subgroup analysis, increasing NI-RADS category at the primary site in surgically treated patients and treatment failure did not achieve statistically significant association (HR, 0.88; P = .82). Conclusion Increasing NI-RADS category at the baseline posttreatment PET/CECT is strongly associated with increased risk of treatment failure in patients with HNSCC.

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Arthritis Increases the Risk for Fractures — Results from the Women’s Health Initiative

The Journal of Rheumatology ◽

10.3899/jrheum.101196 ◽

2011 ◽

Vol 38 (8) ◽

pp. 1680-1688 ◽

Cited By ~ 58

Author(s):

NICOLE C. WRIGHT ◽

BRIAN T. WALITT ◽

CHARLES B. EATON ◽

ZHAO CHEN ◽

Keyword(s):

Hip Fracture ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Spinal Fractures ◽

Fracture Prevention ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Hazards Model ◽

Increased Risk ◽

Clinical Fractures

Objective.To examine the relationship between arthritis and fracture.Methods.Women were classified into 3 self-reported groups at baseline: no arthritis (n = 83,295), osteoarthritis (OA; n = 63,402), and rheumatoid arthritis (RA; n = 960). Incident fractures were self-reported throughout followup. Age-adjusted fracture rates by arthritis category were generated, and the Cox proportional hazards model was used to test the association between arthritis and fracture.Results.After an average of 7.80 years, 24,137 total fractures were reported including 2559 self-reported clinical spinal fractures and 1698 adjudicated hip fractures. For each fracture type, age-adjusted fracture rates were highest in the RA group and lowest in the nonarthritic group. After adjustment for several covariates, report of arthritis was associated with increased risk for spine, hip, and any clinical fractures. Compared to the nonarthritis group, the risk of sustaining any clinical fracture in the OA group was HR 1.09 (95% CI 1.05, 1.13; p < 0.001) and HR 1.49 (95% CI 1.26, 1.75; p < 0.001) in the RA group. The risk of sustaining a hip fracture was not statistically increased in the OA group (HR 1.11; 95% CI 0.98, 1.25; p = 0.122) compared to the nonarthritis group; however, the risk of hip fracture increased significantly (HR 3.03; 95% CI 2.03, 4.51; p < 0.001) in the RA group compared to the nonarthritis group.Conclusion.The increase in fracture risk confirms the importance of fracture prevention in patients with RA and OA.

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Predictors for depressive symptoms by four types of disability

Scientific Reports ◽

10.1038/s41598-021-98765-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sun Wook Jung ◽

Jin-Ha Yoon ◽

Wanhyung Lee

Keyword(s):

Depressive Symptoms ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Depressive Symptomatology ◽

Cox Proportional Hazards ◽

Community Dwelling ◽

Cox Proportional Hazards Model ◽

Mental Disability ◽

Multivariate Logistic Regression Model ◽

Industrial Disaster

AbstractThis study aimed to examine the longitudinal relationship between disability and depressive symptoms, by comparing four types of disability in community-dwelling individuals with disabilities in South Korea. A total of 3347 South Koreans with disabilities from the second wave of the Panel Survey of Employment for the Disabled was utilized. Depressive symptomatology was assessed by whether the participant had experienced depressive symptoms for more than two weeks during the past year. A multivariate logistic regression model was used to calculate the odds ratio (OR) for depressive symptoms, and a Cox proportional hazards model to calculate the hazard ratio (HR) for two-year survival analysis. Persons who acquired mental disability from accident or industrial disaster and persons with congenital physical-internal disability were at higher risk for depressive symptoms. Maintaining employment was found to be an effective way to decrease the risk of depressive symptoms in persons with physical-external disability, sensory/speech disability, or mental disability. In contrast, in physical-internal disability, retaining normal ability to work seemed to be the key to reduce the risk of depressive symptoms. Predictors of depressive symptoms were found to differ depending on the type of disability. Such differences should be reflected in clinical and policy-level interventions to address the specific psychiatric needs of persons with different disabilities.

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