scholarly journals Recruitment and Baseline Characteristics of Participants in the AgeWell.de Study—A Pragmatic Cluster-Randomized Controlled Lifestyle Trial against Cognitive Decline

2021 ◽  
Vol 18 (2) ◽  
pp. 408
Author(s):  
Susanne Röhr ◽  
Andrea Zülke ◽  
Melanie Luppa ◽  
Christian Brettschneider ◽  
Marina Weißenborn ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Cognitive Decline ◽  
Large Scale ◽  
Sociodemographic Factors ◽  
Cognitive States ◽  
Dementia Risk ◽  
Study Population ◽  
Baseline Characteristics ◽  
Cluster Randomized

Targeting dementia prevention, first trials addressing multiple modifiable risk factors showed promising results in at-risk populations. In Germany, AgeWell.de is the first large-scale initiative investigating the effectiveness of a multi-component lifestyle intervention against cognitive decline. We aimed to investigate the recruitment process and baseline characteristics of the AgeWell.de participants to gain an understanding of the at-risk population and who engages in the intervention. General practitioners across five study sites recruited participants (aged 60–77 years, Cardiovascular Risk Factors, Aging, and Incidence of Dementia/CAIDE dementia risk score ≥ 9). Structured face-to-face interviews were conducted with eligible participants, including neuropsychological assessments. We analyzed group differences between (1) eligible vs. non-eligible participants, (2) participants vs. non-participants, and (3) between intervention groups. Of 1176 eligible participants, 146 (12.5%) dropped out before baseline; the study population was thus 1030 individuals. Non-participants did not differ from participants in key sociodemographic factors and dementia risk. Study participants were M = 69.0 (SD = 4.9) years old, and 52.1% were women. The average Montreal Cognitive Assessment/MoCA score was 24.5 (SD = 3.1), indicating a rather mildly cognitively impaired study population; however, 39.4% scored ≥ 26, thus being cognitively unimpaired. The bandwidth of cognitive states bears the interesting potential for differential trial outcome analyses. However, trial conduction is impacted by the COVID-19 pandemic, requiring adjustments to the study protocol with yet unclear methodological consequences.

scholarly journals Development of the First WHO Guidelines for Risk Reduction of Cognitive Decline and Dementia: Lessons Learned and Future Directions

2021 ◽  
Vol 12 ◽  
Author(s):  
Ruth Stephen ◽  
Mariagnese Barbera ◽  
Ruth Peters ◽  
Nicole Ee ◽  
Lidan Zheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Decline ◽  
Risk Reduction ◽  
Individual Risk ◽  
Who Guidelines ◽  
Dementia Risk ◽  
Dementia Prevention ◽  
Multidomain Intervention ◽  
Intervention Trials ◽  
Individual Risk Factors

The first WHO guidelines for risk reduction of cognitive decline and dementia marked an important milestone in the field of dementia prevention. In this paper, we discuss the evidence reviewed as part of the guidelines development and present the main themes emerged from its synthesis, to inform future research and policies on dementia risk reduction. The role of intervention effect-size; the mismatch between observational and intervention-based evidence; the heterogeneity of evidence among intervention trials; the importance of intervention duration; the role of timing of exposure to a certain risk factor and interventions; the relationship between intervention intensity and response; the link between individual risk factors and specific dementia pathologies; and the need for tailored interventions emerged as the main themes. The interaction and clustering of individual risk factors, including genetics, was identified as the overarching theme. The evidence collected indicates that multidomain approaches targeting simultaneously multiple risk factors and tailored at both individual and population level, are likely to be most effective and feasible in dementia risk reduction. The current status of multidomain intervention trials aimed to cognitive impairment/dementia prevention was also briefly reviewed. Primary results were presented focusing on methodological differences and the potential of design harmonization for improving evidence quality. Since multidomain intervention trials address a condition with slow clinical manifestation—like dementia—in a relatively short time frame, the need for surrogate outcomes was also discussed, with a specific focus on the potential utility of dementia risk scores. Finally, we considered how multidomain intervention could be most effectively implemented in a public health context and the implications world-wide for other non-communicable diseases targeting common risk factors, taking into account the limited evidence in low-middle income countries. In conclusion, the evidence from the first WHO guidelines for risk reduction of cognitive decline and dementia indicated that “one size does not fit all,” and multidomain approaches adaptable to different populations and individuals are likely to be the most effective. Harmonization in trial design, the use of appropriate outcome measures, and sustainability in large at-risk populations in the context of other chronic disorders also emerged as key elements.

scholarly journals Multimodal Brain Age Gap as a Mediating Indicator in the Relation between Modifiable Dementia Risk Factors and Cognitive Functioning

2020 ◽  
Author(s):  
Chang-Le Chen ◽  
Pin-Yu Chen ◽  
Yu-Hung Tung ◽  
Yung-Chin Hsu ◽  
Wen-Yih Isaac Tseng
Keyword(s):  
Risk Factors ◽  
Cognitive Decline ◽  
Cognitive Aging ◽  
Prediction Models ◽  
Equation Modeling ◽  
Pathophysiological Mechanism ◽  
Cognitive Changes ◽  
Age Gap ◽  
Dementia Risk ◽  
Brain Age

AbstractIntroductionAs a structural proxy for evaluating brain health, neuroimaging-based brain age gap (BAG) is presumed to link the dementia risks to cognitive changes in the premorbid phase, but this remains unclear.MethodsBrain age prediction models were constructed and applied to a population-based cohort (N=371) to estimate their BAG. Further, structural equation modeling was employed to investigate the mediation effect of BAG between risk levels (assessed by 2 dementia-related risk scores) and cognitive changes (examined by 4 cognitive assessments).ResultsA higher burden of modifiable dementia risk factors was causally associated with a greater cognitive decline, and this was significantly mediated (P=0.017) by a larger multimodal BAG, which indicated an older brain. Moreover, a steeper slope (P=0.020) of association between cognitive decline and multimodal BAG was observed when individuals had higher dementia risks.DiscussionMultimodal BAG is a potential mediating indicator to reflect the changes in the pathophysiological mechanism of cognitive aging.

scholarly journals A Model of Disparities: Risk Factors Associated with COVID-19 Infection

2020 ◽  
Author(s):  
Yelena Rozenfeld ◽  
Jennifer Beam ◽  
Haley Maier ◽  
Whitney Haggerson ◽  
Karen Boudreau ◽  
...  
Keyword(s):  
Risk Factors ◽  
English Language ◽  
Sociodemographic Factors ◽  
Black African ◽  
Factors Associated ◽  
Emerging Risk ◽  
Study Population ◽  
Structural Inequities ◽  
African American Race ◽  
The U.S

Abstract Background By mid-May 2020, there were over 1.5 million cases of (SARS-CoV-2) or COVID-19 across the U.S. with new confirmed cases continuing to rise following the re-opening of most states. Prior studies have focused mainly on clinical risk factors associated with serious illness and mortality of COVID-19. Emerging risk factors in the U.S., including clinical, sociodemographic, and environmental variables associated with contraction of COVID-19 have not been widely studied to assess disparities across populations. Methods A multivariable statistical model was used to identify predictors associated with COVID-19 contraction in the study population of 34,503 patients, comparing laboratory confirmed positive and negative COVID-19 cases in the Providence Health System (U.S.) between February 28 and April 27, 2020. Publicly available data were utilized as approximations for social determinants of health, and patient-level clinical and sociodemographic factors were extracted from the electronic medical record. Results Higher risk of contraction was associated with older age (OR 1.69; 95% CI 1.41-2.02, p<0.0001), male gender (OR 1.32; 95% CI 1.21-1.44, p<0.0001), Asian race (OR 1.43; 95% CI 1.18-1.72, p= 0.0002), Black/African American race (OR 1.51; 95% CI 1.25-1.83, p<0.0001), Latino ethnicity (OR 2.07; 95% CI 1.77-2.41, p<0.0001), non-English language (OR 2.09; 95% CI 1.7-2.57, p<0.0001), high school education or less (OR 1.02; 95% CI 1.01-1.14, p=0.04), residing in a neighborhood with financial insecurity (OR 1.10; 95% CI 1.01-1.25, p=0.04), low air quality (OR 1.01; 95% CI 1.0-1.04, p=0.05), housing insecurity (OR 1.32; 95% CI 1.16-1.5, p< 0.0001) or transportation insecurity (OR 1.11; 95% CI 1.02-1.23, p=0.03), and living in senior living communities (OR 1.69; 95% CI 1.23-2.32, p= 0.001). Conclusions Risks associated with COVID-19 contraction reflect disparities across age, race, ethnicity, language, socioeconomic status, and living conditions. Health promotion and disease prevention strategies should prioritize groups most vulnerable to contraction and address structural inequities that contribute to risk through social and economic policy.

Feasibility and Preliminary Efficacy of the Lifestyle, Exercise and Diet (LEAD) Study: A Cluster Randomized Controlled Trial of a Combined Exercise and Diet Intervention in Older Adults with Vascular Risk Factors and Early Dementia Risk

2021 ◽  
Author(s):  
Noah Koblinsky ◽  
Nicole Anderson ◽  
Fatim Ajwani ◽  
Matthew Parrott ◽  
Deirdre Dawson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Health Education ◽  
Healthy Eating ◽  
Vascular Risk ◽  
Brain Health ◽  
Dietary Counselling ◽  
Dementia Risk ◽  
Early Dementia ◽  
Cluster Randomized

Abstract Background: Healthy diet and exercise are associated with reduced risk of dementia in older adults. Evidence for the impact of clinical trials on brain health is less consistent, especially with dietary interventions which often rely on varying intervention approaches. Our objective was to evaluate the feasibility and preliminary efficacy of a 6-month intervention combining exercise with a novel dietary counselling approach among older adults with vascular risk factors (VRFs) and early dementia risk. Methods: Participants with VRF’s and SCD or early MCI were cluster randomized into the intervention (exercise + Baycrest Brain-healthy Eating Approach (EX+DIET)) or control group (exercise + brain health education (EX+ED)). Both groups participated in 1-hour of supervised exercise per week and were prescribed additional exercise at home. EX+DIET involved 1-hour per week of group-based dietary counselling comprising didactic education focused on brain healthy eating recommendations, goal setting and strategy training. Whereas, EX+ED involved 1-hour per week of group-based brain health education. The primary outcome was change in hippocampal volume from baseline to 6 months. Secondary outcomes included fitness, diet, cognition, and blood biomarkers. Recruitment challenges and early discontinuation of the trial due to COVID-19 necessitated a revised focus on feasibility and preliminary efficacy. Results: Of 190 older adults contacted, 14 (7%) were eligible and randomized, constituting 21% of our recruitment target. All participants completed the intervention and attended 90% of exercise and diet/education sessions on average. All 6-month follow-up assessments pre-COVID-19 were completed but disruptions to testing during the pandemic resulted in incomplete data collection. No serious adverse events occurred and all participants expressed positive feedback about the intervention. Mean improvements in peak oxygen consumption were observed in both EX+DIET (d = .98) and EX+ED (d =1.15) groups. Substantial improvements in diet and HbA1c were observed in the EX+DIET group compared to EX+ED (d = 1.75 and 1.07, respectively). Conclusions: High adherence and retention rates were observed among LEAD participants and preliminary findings illustrate improvements in cardiorespiratory fitness and diet quality. These results indicate that a larger trial is feasible if difficulties surrounding recruitment can be mitigated. Trial Registration: ClinicalTrials.gov identifier: NCT03056508

Can older “at risk” adults benefit from psychoeducation targeting healthy brain aging?

2010 ◽  
Vol 23 (3) ◽  
pp. 413-424 ◽  
Author(s):  
Louisa M. Norrie ◽  
Keri Diamond ◽  
Ian B. Hickie ◽  
Naomi L. Rogers ◽  
Samantha Fearns ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Cognitive Decline ◽  
Repeated Measures ◽  
Brain Aging ◽  
Self Report ◽  
Control Group ◽  
Vascular Risk ◽  
Late Life Depression

ABSTRACTBackground:Multifactorial strategies that prevent or delay the onset or progress of cognitive decline and dementia are needed, and should include education regarding recognized risk factors. The current study sought to investigate whether older adults “at risk” of cognitive decline benefit from psychoeducation targeting healthy brain aging.Methods:65 participants (mean age 64.8 years, SD 9.6) with a lifetime history of major depression; vascular risk as evidenced by at least one vascular risk factor; and/or subjective or objective memory impairment were allocated to weekly psychoeducation sessions or a waitlist control group. The small group sessions were conducted over ten weeks by a team of medical and allied health professionals with expertise in late-life depression and cognition. Sessions focused on modifiable risk factors for cognitive decline including vascular risk, diet, exercise, depression, anxiety and sleep disturbance, as well as providing practical strategies for memory and cognition. Both the psychoeducation and waitlist group completed a 20-item knowledge test at baseline and follow-up. Participants in the psychoeducation group were asked to complete follow-up self-report satisfaction questionnaires.Results:Repeated measures ANOVA showed a significant interaction effect depicting improvements in knowledge associated with psychoeducation, corresponding to an improvement of 15% from baseline. Satisfaction data additionally showed that 92.3% of participants rated the program as “good” to “excellent”, and over 90% suggested they would recommend it to others.Conclusions:A group-based psychoeducation program targeting healthy brain aging is effective in improving knowledge. Additionally, it is acceptable and rated highly by participants.

scholarly journals Baseline characteristics and risk factors for ulcer, amputation and severe neuropathy in diabetic foot at risk: the BRAZUPA study

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Maria Candida R. Parisi ◽  
Arnaldo Moura Neto ◽  
Fabio H. Menezes ◽  
Marilia Brito Gomes ◽  
Rodrigo Martins Teixeira ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Diabetic Foot ◽  
Baseline Characteristics

scholarly journals Diet May Moderate the Relationship Between Arterial Stiffness and Cognitive Performance in Older Adults

2021 ◽  
pp. 1-14
Author(s):  
Sarah Gauci ◽  
Lauren M. Young ◽  
David J. White ◽  
Jeffery M. Reddan ◽  
Annie-Claude Lassemillante ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
At Risk ◽  
Arterial Stiffness ◽  
Cognitive Decline ◽  
Cognitive Performance ◽  
Diet Quality ◽  
Glucose Control ◽  
Verbal Learning ◽  
The Relationship

Background: Cognitive decline is influenced by various factors including diet, cardiovascular disease, and glucose control. However, the combined effect of these risk factors on cognitive performance is yet to be fully understood. Objective: The current study aimed to explore the inter-relationship between these risk factors and cognitive performance in older adults at risk of future cognitive decline. Methods: The sample comprised 163 (Age: M = 65.23 years, SD = 6.50) participants. Food Frequency Questionnaire data was used to score diet quality and adherence to the Western Style Diet (WSD) and Prudent Style Diet (PSD). Glucose control was gauged by serum levels of glycated hemoglobin (HbA1c) and arterial stiffness was measured using carotid to femoral pulse wave velocity. Cognitive performance was assessed using two subtests of the Swinburne University Computerized Cognitive Assessment Battery (SUCCAB) and Rey’s Verbal Learning Test (RVLT). Results: Diet quality, adherence to the WSD or PSD, and glucose control were not significantly related to cognitive outcomes. However, a significant negative association was found between arterial stiffness and the spatial working memory subtest of SUCCAB (β= –0.21, p <  0.05). Arterial stiffness also significantly interacted with the PSD to impact total recall (F change (1,134) = 5.37, p <  0.05) and the composite score of RVLT (F change (1,134) = 4.03, p <  0.05). Conclusion: In this sample of older adults at risk of cognitive decline, diet alone was not found to predict cognitive performance; however, it was found to moderate the relationship between arterial stiffness and cognition.

scholarly journals Identification of Risk Factors for Suicidal Ideation and Attempt Based on Machine Learning Algorithms: A Longitudinal Survey in Korea (2007–2019)

2021 ◽  
Vol 18 (23) ◽  
pp. 12772
Author(s):  
Junggu Choi ◽  
Seoyoung Cho ◽  
Inhwan Ko ◽  
Sanghoon Han
Keyword(s):  
Machine Learning ◽  
Risk Factors ◽  
Suicidal Ideation ◽  
Suicide Risk ◽  
Large Scale ◽  
Learning Algorithms ◽  
Sociodemographic Factors ◽  
Classification Performance ◽  
Machine Learning Algorithms ◽  
Support Vector

Investigating suicide risk factors is critical for socioeconomic and public health, and many researchers have tried to identify factors associated with suicide. In this study, the risk factors for suicidal ideation were compared, and the contributions of different factors to suicidal ideation and attempt were investigated. To reflect the diverse characteristics of the population, the large-scale and longitudinal dataset used in this study included both socioeconomic and clinical variables collected from the Korean public. Three machine learning algorithms (XGBoost classifier, support vector classifier, and logistic regression) were used to detect the risk factors for both suicidal ideation and attempt. The importance of the variables was determined using the model with the best classification performance. In addition, a novel risk-factor score, calculated from the rank and importance scores of each variable, was proposed. Socioeconomic and sociodemographic factors showed a high correlation with risks for both ideation and attempt. Mental health variables ranked higher than other factors in suicidal attempts, posing a relatively higher suicide risk than ideation. These trends were further validated using the conditions from the integrated and yearly dataset. This study provides novel insights into suicidal risk factors for suicidal ideations and attempts.

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