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 Risk factors for interpersonal violence: an umbrella review of meta-analyses

2018 ◽  
Vol 213 (4) ◽  
pp. 609-614 ◽  
Author(s):  
Seena Fazel ◽  
E. Naomi Smith ◽  
Zheng Chang ◽  
John Richard Geddes
Keyword(s):  
Risk Factors ◽  
Systematic Reviews ◽  
Interpersonal Violence ◽  
Research Evidence ◽  
Small Study ◽  
Modifiable Risk Factors ◽  
Umbrella Review ◽  
Population Effect ◽  
Health And Social Care ◽  
Meta Analyses

BackgroundInterpersonal violence is a leading cause of morbidity and mortality. The strength and population effect of modifiable risk factors for interpersonal violence, and the quality of the research evidence is not known.AimsWe aimed to examine the strength and population effect of modifiable risk factors for interpersonal violence, and the quality and reproducibility of the research evidence.MethodWe conducted an umbrella review of systematic reviews and meta-analyses of risk factors for interpersonal violence. A systematic search was conducted to identify systematic reviews and meta-analyses in general population samples. Effect sizes were extracted, converted into odds ratios and synthesised, and population attributable risk fractions (PAF) were calculated. Quality analyses were performed, including of small study effects, adjustment for confounders and heterogeneity. Secondary analyses for aggression, intimate partner violence and homicide were conducted, and systematic reviews (without meta-analyses) were summarised.ResultsWe identified 22 meta-analyses reporting on risk factors for interpersonal violence. Neuropsychiatric disorders were among the strongest in relative and absolute terms. The neuropsychiatric risk factor that had the largest effect at a population level were substance use disorders, with a PAF of 14.8% (95% CI 9.0–21.6%), and the most important historical factor was witnessing or being a victim of violence in childhood (PAF = 12.2%, 95% CI 6.5–17.4%). There was evidence of small study effects and large heterogeneity.ConclusionsNational strategies for the prevention of interpersonal violence may need to review policies concerning the identification and treatment of modifiable risk factors.Declarations of interestJ.R.G. is an NIHR Senior Investigator. The views expressed within this article are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

scholarly journals Global assessment of C-reactive protein and health-related outcomes: an umbrella review of evidence from observational studies and Mendelian randomization studies

2020 ◽  
Author(s):  
Georgios Markozannes ◽  
Charalampia Koutsioumpa ◽  
Sofia Cividini ◽  
Grace Monori ◽  
Konstantinos K. Tsilidis ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Systematic Reviews ◽  
Observational Studies ◽  
Mendelian Randomization ◽  
Convincing Evidence ◽  
Mr Studies ◽  
C Reactive Protein ◽  
Umbrella Review ◽  
Reactive Protein ◽  
Meta Analyses

Abstract C-reactive protein (CRP) has been studied extensively for association with a large number of non-infectious diseases and outcomes. We aimed to evaluate the breadth and validity of associations between CRP and non-infectious, chronic health outcomes and biomarkers. We conducted an umbrella review of systematic reviews and meta-analyses and a systematic review of Mendelian randomization (MR) studies. PubMed, Scopus, and Cochrane Database of Systematic Reviews were systematically searched from inception up to March 2019. Meta-analyses of observational studies and MR studies examining associations between CRP and health outcomes were identified, excluding studies on the diagnostic value of CRP for infections. We found 113 meta-analytic comparisons of observational studies and 196 MR analyses, covering a wide range of outcomes. The overwhelming majority of the meta-analyses of observational studies reported a nominally statistically significant result (95/113, 84.1%); however, the majority of the meta-analyses displayed substantial heterogeneity (47.8%), small study effects (39.8%) or excess significance (41.6%). Only two outcomes, cardiovascular mortality and venous thromboembolism, showed convincing evidence of association with CRP levels. When examining the MR literature, we found MR studies for 53/113 outcomes examined in the observational study meta-analyses but substantial support for a causal association with CRP was not observed for any phenotype. Despite the striking amount of research on CRP, convincing evidence for associations and causal effects is remarkably limited.

scholarly journals A comparison of the prevalence of and modifiable risk factors for cognitive impairment among community-dwelling Canadian seniors over two decades, 1991–2009

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0242911
Author(s):  
Batholomew Chireh ◽  
Carl D’Arcy
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
Cognitive Impairment ◽  
Healthy Aging ◽  
Canadian Community Health Survey ◽  
Community Dwelling ◽  
Health Concern ◽  
Population Census ◽  
Modifiable Risk Factors ◽  
Canadian Population

Background The prevalence of cognitive impairment or dementia is of public health concern globally. Accurate estimates of this debilitating condition are needed for future public health policy planning. In this study, we estimate prevalence and modifiable risk factors for cognitive impairment by sex over approximately 16 years. Methods Canadian Study of Health and Aging (CSHA) baseline data conducted between 1991–1992 were used to measure the prevalence of cognitive impairment and dementia among adults aged 65+ years. The standard Modified Mini-Mental State Examination (3MS) was used for the screening test for cognitive impairment. We compared the CSHA data with Canadian Community Health Survey–Healthy Aging (CCHS-HA) conducted between 2008–2009. The CCHS-HA used a four-dimension cognitive module to screen for cognitive impairment. Only survey community-dwelling respondents were included in the final sample. After applying exclusion criteria, final samples of (N = 8504) respondents in the CSHA sample and (N = 7764) respondents for CCHS–HA sample were analyzed. To account for changes in the age structure of the Canadian population, prevalence estimates were calculated using age-sex standardization to the 2001 population census of Canada. Logistic regression analyses were used to examine predictors of cognitive impairment. A sex stratified analysis was used to examine risk factors for cognitive impairment in the survey samples. Results We found that prevalence of cognitive impairment among respondents in CSHA sample was 15.5% in 1991 while a prevalence of 10.8% was reported in the CCHS–HA sample in 2009, a 4.7% reduction [15.5% (CI = 14.8–16.3), CSHA vs 10.8% (CI = 10.1–11.5), CCHS–HA]. Men reported higher prevalence of cognitive impairment in CSHA study (16.0%) while women reported higher prevalence of cognitive impairment in CCHS–HA (11.6%). In the multivariable analyses, risk factors such as age, poor self-rated health, stroke, Parkinson’s disease, and hearing problems were common to both cohorts. Sex differences in risk factors were also noted. Conclusions This study provides suggestive evidence of a potential reduction in the occurrence of cognitive impairment among community-dwelling Canadian seniors despite the aging of the Canadian population. The moderating roles of improved prevention and treatment of vascular morbidity and improvements in the levels of education of the Canadian population are possible explanations for this decrease in the cognitive impairment.

scholarly journals Effectiveness of interventions to prevent falls for people with multiple sclerosis, Parkinson’s disease and stroke: an umbrella review

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nicola O’Malley ◽  
Amanda M. Clifford ◽  
Mairéad Conneely ◽  
Bláthín Casey ◽  
Susan Coote
Keyword(s):  
Risk Factors ◽  
Multiple Sclerosis ◽  
Systematic Reviews ◽  
Methodological Quality ◽  
Falls Prevention ◽  
Umbrella Review ◽  
Falls Risk ◽  
Prevention Interventions ◽  
Evidence Table

Abstract Background The implementation of condition-specific falls prevention interventions is proving challenging due to lack of critical mass and resources. Given the similarities in falls risk factors across stroke, Parkinson’s Disease (PD) and Multiple Sclerosis (MS), the development of an intervention designed for groups comprising of people with these three neurological conditions may provide a pragmatic solution to these challenges. The aims of this umbrella review were to investigate the effectiveness of falls prevention interventions in MS, PD and stroke, and to identify the commonalities and differences between effective interventions for each condition to inform the development of an intervention for mixed neurological groups. Methods A systematic literature search was conducted using 15 electronic databases, grey literature searches and hand-screening of reference lists. Systematic reviews of studies investigating the effects of falls prevention interventions in MS, PD and stroke were included. Methodological quality of reviews was assessed using the A MeaSurement Tool to Assess Systematic Reviews 2. A matrix of evidence table was used to assess the degree of overlap. The Grading of Recommendations Assessments, Development and Evaluation framework was used to rate the quality of evidence. Findings were presented through narrative synthesis and a summary of evidence table. Results Eighteen reviews were included; three investigating effectiveness of falls prevention interventions in MS, 11 in PD, three in stroke, and one in both PD and stroke. Exercise-based interventions were the most commonly investigated for all three conditions, but differences were identified in the content and delivery of these interventions. Low to moderate quality evidence was found for the effectiveness of exercise-based interventions at reducing falls in PD. Best available evidence suggests that exercise is effective at reducing falls in stroke but no evidence of effect was identified in MS. Conclusions The findings suggest that exercise-based interventions are effective at reducing falls in PD, however, the evidence for MS and stroke is less conclusive. A strong theoretical rationale remains for the use of exercise-based interventions to address modifiable physiological falls risk factors for people with MS, PD and stroke, supporting the feasibility of a mixed-diagnosis intervention. Given the high overlap and low methodological quality of primary studies, the focus should be on the development of high-quality trials investigating the effectiveness of falls prevention interventions, rather than the publication of further systematic reviews.

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