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BACKGROUND: The gut microbiome is a complex system within the human gastrointestinal tract. The bacteria play a significant role in human health, and some can promote inflammation and pathologic processes through chemical interactions or metabolites. Gut microbiome dysbiosis has been linked to some neurological and other diseases. Here we aimed to examine microbiome differences between patients with a progressive neurological disorder, idiopathic normal pressure hydrocephalus (iNPH), compared with healthy controls (CO). METHODS: We recruited 37 neurologically healthy CO and 10 patients with shunted iNPH. We evaluated these participants' cognition using the CERAD-NB test battery and CDR test, and collected a variety of information, including about dietary habits and health. We also collected fecal samples, which were subjected to 16S amplicon sequencing to analyze differences in gut microbiome composition. RESULTS: We found that the iNPH group exhibited significantly different abundances of 10 bacterial genera compared with the CO group. The Escherichia/Shigella and Anaeromassilibacillus genera were most remarkably increased. Other increased genera were Butyrivibrio , Duncaniella , and an unidentified genus. The decreased genera were Agathobaculum , Paramuribaculum , Catenibacterium , and 2 unidentified genera. CONCLUSIONS: Here we report the first identified microbiome differences in iNPH patients compared with healthy controls.
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Microbioma Gastrointestinal , Hidrocéfalo Normotenso , Humanos , Microbioma Gastrointestinal/fisiología , Hidrocéfalo Normotenso/microbiología , Masculino , Femenino , Anciano , Disbiosis/microbiología , Heces/microbiología , Anciano de 80 o más Años , Estudios de Casos y Controles , Persona de Mediana Edad , ARN Ribosómico 16S/genéticaRESUMEN
BACKGROUND: Functional defects in eye movements and reduced reading speed in neurodegenerative diseases represent a potential new biomarker to support clinical diagnosis. We investigated whether computer-based eye-tracking (ET) analysis of the King-Devick (KD) test differentiates persons with idiopathic normal pressure hydrocephalus (iNPH) from cognitively unimpaired [control (CO)] and persons with Alzheimer's disease (AD). METHODS: We recruited 68 participants (37 CO, 10 iNPH, and 21 AD) who underwent neurological examination, the Consortium to Establish a Registry for Alzheimer's Disease neuropsychological test battery (CERAD-NB), and a Clinical Dementia Rating interview. The KD reading test was performed using computer-based ET. We analyzed the total time used for the reading test, number of errors, durations of fixation and saccade, and saccade amplitudes. RESULTS: The iNPH group significantly differed from the CO group in the KD test mean total time (CO 69.3 s, iNPH 87.3 s; P ≤0.009) and eye-tracking recording of the mean saccade amplitude (CO 3.6 degree, iNPH 3.2 degree; P ≤0.001). The AD group significantly differed from the CO group in each tested parameter. No significant differences were detected between the iNPH and AD groups. CONCLUSION: For the first time, we demonstrated altered reading ability and saccade amplitudes in patients with iNPH.
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Enfermedad de Alzheimer , Hidrocéfalo Normotenso , Humanos , Hidrocéfalo Normotenso/diagnóstico , Hidrocéfalo Normotenso/psicología , Hidrocéfalo Normotenso/cirugía , Tecnología de Seguimiento Ocular , Pruebas Neuropsicológicas , BiomarcadoresRESUMEN
BACKGROUND: Wide-ranging functional defects in eye movements have been reported in Alzheimer's disease (AD) dementia. The detection of abnormal eye movements and reading problems may identify persons at risk of AD when clear clinical symptoms are lacking. OBJECTIVE: To examine whether computer-based eye-tracking (ET) analysis of King-Devick (KD) test results differentiates cognitively healthy persons from persons with minor problems in cognitive testing or diagnosed mild AD. METHODS: We recruited 78 participants (57 non-demented, 21 with mild AD) who underwent neurological examination, the Consortium to Establish a Registry for Alzheimer's Disease neuropsychological test battery (CERAD-NB), and a Clinical Dementia Rating (CDR) interview. The non-demented participants were further divided into control (normal CERAD subtests, mean MMSEâ=â28) and objective mild cognitive impairment (MCI; decline in at least one CERAD memory score, mean MMSEâ=â27) groups. The KD reading test was performed using computer-based ET. The total time used for the reading test, errors made, fixation and saccade durations, and saccade amplitudes were analyzed. RESULTS: We found significant differences between the control, objective MCI, and AD groups in regard to the mean saccade amplitude (3.58, 3.33, and 3.21âms, respectively, pâ<â0.03) and duration (27.1, 25.3, and 24.8âms, respectively, pâ<â0.05). The KD error scores in the AD group differed significantly (pâ<â0.01) from the other groups. CONCLUSION: Computed ET analysis of the KD test may help detect persons with objective MCI early when clear clinical symptoms are lacking. The portable device for ET is easy to use in primary health care memory clinics.
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Enfermedad de Alzheimer , Disfunción Cognitiva , Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/psicología , Biomarcadores , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/psicología , Humanos , Pruebas Neuropsicológicas , Movimientos SacádicosRESUMEN
OBJECTIVES: Human-animal interactions have beneficial psychosocial and psychophysiological effects on individuals in both the presence and absence of medical health conditions. No previous prospective studies with long follow-up have investigated the effects of domestic pets on individuals with Alzheimer's disease (AD) who live at home. We examined the effects of pets on quality of life (QoL) and general well-being during a 5-year follow-up of home-dwelling persons with AD. METHODS: In a prospective study including 223 patients with very mild (Clinical Dementia Rating Scale [CDR] 0.5) or mild (CDR 1) AD at baseline who participated in the ALSOVA study, 40 (18%) had a pet. Self- and proxy-rated QoL in AD quality of life-AD (QoL-AD), 15D, and self-rated visual analogic scale (VAS) were assessed annually for 3 years and after 5 years. The Mini-Mental State Examination, Neuropsychiatric Inventory, and CDR sum of boxes (CDR sum of boxes) were measured at the same visits. RESULTS: A significant positive effect of pet ownership (p = 0.003, proxy-rated QoL-AD) on QoL was found over the entire follow-up. However, self-rated QoL-AD, 15D, and VAS did not significantly differ between pet owners and non-pet owners. CONCLUSIONS: The findings suggest that having a pet may support QoL in home-dwelling persons with AD. Self-rated or general QoL or well-being measurements are not an accurate method for studying QoL in individuals with dementia over time due to a lack of insight. Adding proxy-rated evaluations to this kind of study is recommended.
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AIMS: Joint prevention of cardiovascular disease (CVD) and dementia could reduce the burden of both conditions. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) demonstrated a beneficial effect on cognition (primary outcome) and we assessed the effect of this lifestyle intervention on incident CVD (pre-specified secondary outcome). METHODS AND RESULTS: FINGER enrolled 1259 individuals aged 60-77 years (ClinicalTrials.gov NCT01041989). They were randomized (1:1) to a 2-year multi-domain intervention with diet, physical and cognitive activity, and vascular monitoring (n = 631), or general health advice (n = 628). National registries provided data on CVD including stroke, transient ischaemic attack (TIA), or coronary heart event. During an average of 7.4 years, 229 participants (18%) had at least one CVD diagnosis: 107 in the intervention group and 122 in the control group. The incidence of cerebrovascular events was lower in the intervention than the control group: hazard ratio (HR) for combined stroke/TIA was 0.71 [95% confidence interval (CI): 0.51-0.99] after adjusting for background characteristics. Hazard ratio for coronary events was 0.84 (CI: 0.56-1.26) and total CVD events 0.80 (95% CI: 0.61-1.04). Among those with history of CVD (n = 145), the incidence of both total CVD events (HR: 0.50, 95% CI: 0.28-0.90) and stroke/TIA (HR: 0.40, 95% CI: 0.20-0.81) was lower in the intervention than the control group. CONCLUSION: A 2-year multi-domain lifestyle intervention among older adults was effective in preventing cerebrovascular events and also total CVD events among those who had history of CVD.
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Enfermedades Cardiovasculares , Ataque Isquémico Transitorio , Accidente Cerebrovascular , Anciano , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Factores de Riesgo de Enfermedad Cardiaca , Humanos , Ataque Isquémico Transitorio/epidemiología , Ataque Isquémico Transitorio/prevención & control , Estilo de Vida , Persona de Mediana Edad , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/prevención & controlRESUMEN
BACKGROUND: Human-animal interactions are known to have many beneficial psychosocial and psychophysiological effects on persons with and without medical health conditions. There are no previous prospective studies with long follow-up times on the effects of domestic pets on the persons with Alzheimer's disease (AD) living at home. OBJECTIVE: To investigate the effects of pets on the activities of daily living (ADL), disease progression, and neuropsychiatric symptoms (NPS) during a five-year follow-up on the persons with AD. METHODS: Altogether 223 home-dwelling persons (mean age 75.2 years) with very mild (CDR 0.5) or mild (CDR 1) AD at baseline were included for this study. ADCS-ADL, NPI, MMSE, and CDR-SOB were measured at baseline, annually for three years and after five years. RESULTS: Totally 40 (17.9%) participants had a pet. At the baseline, pet owners and non-pet owners had no significant differences in age, gender, or the ADCS-ADL, NPS, and CDR-SOB scores, while MMSE was lower in pet owners than non-pet owners (20.2 versus 21.7; pâ=â0.009). Over the follow-up, pet owners had significantly better mean ADCS-ADL (57.5 versus 54.0; pâ=â0.031), NPI (9.3 versus 13.0; pâ=â0.038), and CDR-SOB scores (5.7 versus 6.6; pâ=â0.004) compared to non-pet owners. The differences in the MMSE scores between the groups detected at baseline attenuated over time. CONCLUSION: Significant positive effects of the pets on ADL functions, NPS, and disease progression were detected over the whole follow-up suggesting that having a pet may support daily activity and slow the disease progression in AD.
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Actividades Cotidianas/psicología , Enfermedad de Alzheimer/psicología , Pruebas Neuropsicológicas/estadística & datos numéricos , Propiedad , Anciano , Animales , Progresión de la Enfermedad , Femenino , Humanos , Vida Independiente , Masculino , Mascotas , Estudios ProspectivosRESUMEN
BACKGROUND: The prevalence of abdominal aortic aneurysms is higher in population with other vascular comorbidities, especially among men. Utility of screening among patients with cerebrovascular disease is unclear. OBJECTIVE: To determine the prevalence of abdominal aortic aneurysm in male patients with diagnosed cerebrovascular disease manifested by transient ischemic attack or stroke. METHODS: Between May 2013 and May 2014, all consecutive male patients undergoing carotid ultrasound in single tertiary center with a catchment area of 179,000 inhabitants were evaluated for ultrasound screening of abdominal aortic aneurysm. Abdominal aortic aneurysm was defined as maximum diameter of infrarenal aorta 30 mm or more. RESULTS: Of 105 (n = 105) consecutively evaluated male patients, only 69% (n = 72) were eligible for the study and underwent aortic screening. Reason for ineligibility was most often poor general medical condition (n = 29). Mean age of screened patients was 66 years (SD 9.8 years). Half of the screened patients suffered stroke (n = 36). The incidence of abdominal aortic aneurysm was 5.6% (n = 4). All found abdominal aortic aneurysms were small and did not require immediate surgical intervention. During a follow-up period of over 4 years, none of the aneurysms exhibited tendency for growth. CONCLUSIONS: The male population with cerebrovascular disease is comorbid and frail. Only, moderate prevalence of abdominal aortic aneurysms can be found in this subpopulation.
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Aneurisma de la Aorta Abdominal , Trastornos Cerebrovasculares , Anciano , Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/epidemiología , Trastornos Cerebrovasculares/diagnóstico por imagen , Trastornos Cerebrovasculares/epidemiología , Trastornos Cerebrovasculares/etiología , Humanos , Masculino , Estudios Prospectivos , Factores de Riesgo , UltrasonografíaRESUMEN
BACKGROUND: The oldest old is the fastest growing age group worldwide and the most prone to severe disability, especially in relation to loss of cognitive function. Improving our understanding of the predictors of cognitive, physical and psychosocial wellbeing among the oldest old can result in substantial benefits for the individuals and for the society as a whole. The Cardiovascular Risk Factors, Aging and Dementia (CAIDE) study investigated risk factors and determinants of cognitive impairment in a population-based longitudinal cohort, which was first examined between 1972 and 1992, when individuals were in their midlife, and re-assessed in 1998 and 2005-2009. Most of the study participants are currently aged 85 years or older. We aim to re-examine the cohort's survivors and gain further insights on the mechanisms underlying both cognitive and overall healthy ageing at old age. METHODS: CAIDE85+ is the third follow-up of the CAIDE study participants. All individuals still alive and living in the Kuopio and Joensuu areas of Eastern Finland, from the original CAIDE cohort (two random samples, N = 2000 + ~ 900), will be invited to a re-examination. The assessment includes self-reported data related to basic demographics and lifestyle, as well as psychosocial and physical health status. Cognitive and physical evaluations are also conducted. Blood biomarkers relevant for dementia and ageing are assessed. Primary outcomes are the measurements related to cognition and daily life functioning (CERAD, Trail Making Test-A, Letter-Digit Substitution Test, Clinical Dementia Rating and Activities of Daily Living). Secondary endpoints of the study are outcomes related to physical health status, psychosocial wellbeing, as well as age-related health indicators. DISCUSSION: Through a follow-up of more than 40 years, CAIDE85+ will provide invaluable information on the risk and protective factors that contribute to cognitive and physical health, as well as ageing and longevity. STUDY REGISTRATION: The present study protocol has been registered at https://clinicaltrials.gov/ (registration nr NCT03938727 , date 03.05.2019).
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Enfermedades Cardiovasculares , Disfunción Cognitiva , Demencia , Actividades Cotidianas , Anciano de 80 o más Años , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Cognición , Demencia/diagnóstico , Demencia/epidemiología , Finlandia , Estudios de Seguimiento , Factores de Riesgo de Enfermedad Cardiaca , Humanos , Factores de RiesgoRESUMEN
OBJECTIVES: We examined longitudinal associations between late-life personality traits and cognitive impairment, dementia, and mortality in the population-based Cardiovascular Risk Factors, Aging and Dementia (CAIDE) Study. METHODS: Anger expression and trait anger (State-Trait Anger Expression Inventory), anxiety (State-Trait Anxiety Inventory), and sense of coherence (Sense of Coherence Scale) were assessed at the 1998 CAIDE visit (1266 cognitively normal individuals, mean age 71.0 years). Totally, 582 participants had complete re-examination in 2005-2008 (105 mild cognitive impairment, MCI; and 29 dementia). National registers data until 2008 were also used for both participants and nonparticipants to ascertain incident dementia (96 cases) and mortality (227 died). Analyses were adjusted for age, sex, education, follow-up time, cardiovascular and lifestyle factors, and depressive symptoms. RESULTS: Higher anxiety was associated with higher risk of MCI/dementia (OR 1.68, 95% CI 1.07-2.63) and death (HR 1.46, 95% CI 1.08-1.98). High sense of coherence was associated with lower mortality (HR 0.65, 95% CI 0.45-0.93). These associations were attenuated after accounting for depressive symptoms (OR 1.57, 95% CI 0.96-2.58 for anxiety-MCI/dementia; HR 1.35, 95% CI 0.97-1.86 for anxiety-mortality; and HR 0.68, 95% CI 0.45-1.04 for sense of coherence-mortality). Trait anger was associated with higher dementia risk even after adjustments (HR 1.90, 95% CI 1.14-3.18). CONCLUSIONS: Anxiety was linked to worse cognitive outcome and mortality and sense of coherence to lower mortality. Depressive symptoms attenuated the associations. As a novel finding, trait anger was connected to dementia risk. These findings emphasize the importance of personality-related risk factors for dementia and mortality. J Am Geriatr Soc 68:-, 2020.
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Disfunción Cognitiva , Demencia , Anciano , Estudios de Cohortes , Humanos , Personalidad , Factores de RiesgoRESUMEN
OBJECTIVE: As no causal treatment for dementia is available yet, the focus of dementia research is slowly shifting towards prevention strategies. Therefore, this study aimed to examine the predictive accuracy of the "LIfestyle for BRAin Health" (LIBRA) score, a weighted compound score of 12 modifiable risk and protective factors, for dementia and mild cognitive impairment (MCI) in midlife and late-life, and in individuals with high or low genetic risk based on presence of the apolipoprotein (APOE) ε4 allele. METHODS: The LIBRA score was calculated for participants from the Finnish Cardiovascular Risk Factors, Aging and Dementia (CAIDE) population-based study examined in midlife (n = 1024) and twice in late-life (n = 604) up to 30 years later. Diagnoses of MCI and dementia were made according to established criteria. Cox proportional hazards models were used to assess the association between LIBRA and risk of dementia and MCI in models adjusted for sex and education (age as timescale). RESULTS: Higher midlife LIBRA scores were related to higher risk of dementia (hazard ratio [HR] = 1.27; 95% confidence interval [CI], 1.13-1.43) and MCI (unadjusted model: HR = 1.12; 95% CI, 1.03-1.22) up to 30 years later. Higher late-life LIBRA scores were related to higher risk of MCI (HR = 1.11; 95% CI, 1.00-1.25), but not dementia (HR = 1.02; 95% CI, 0.84-1.24). Higher late-life LIBRA scores were related to higher dementia risk among apolipoprotein E (APOE) ε4 non-carriers. CONCLUSIONS: Findings emphasize the importance of modifiable risk and protective factors for dementia prevention.
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Demencia/epidemiología , Anciano , Apolipoproteínas E/genética , Disfunción Cognitiva/epidemiología , Demencia/genética , Femenino , Estudios de Seguimiento , Predisposición Genética a la Enfermedad , Humanos , Estilo de Vida , Masculino , Factores Protectores , Medición de Riesgo/métodos , Factores de RiesgoRESUMEN
PURPOSE: The aim of this study was to examine the association of serum glucose, insulin, and insulin resistance with cognitive functioning 7 years later in a longitudinal population-based study of Finnish older adults. METHODS: Serum glucose and insulin were measured at baseline in 269 dementia-free individuals aged 65-79 years, from the Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) study. Insulin resistance was estimated with the homeostasis model assessment (HOMA-IR). Participants were reexamined 7 years later, and global cognition, episodic memory, executive functioning, verbal expression, and psychomotor speed were assessed, both at baseline and at follow-up. Multiple linear regression was used to investigate the associations with cognitive performance at follow-up, after adjusting for several potential confounders, including common vascular risk factors. RESULTS: In the multivariable-adjusted linear regression models, no associations of insulin resistance with cognitive functioning were observed. After excluding 19 incident dementia cases, higher baseline HOMA-IR values were related to worse performance in global cognition (ß [standard error (SE)] -.050 [0.02]; Pâ¯=â¯.043) and psychomotor speed (ß [SE] -.064 [.03]; Pâ¯=â¯[.043]) 7 years later. Raised serum insulin levels were associated with lower scores on global cognition (ß [SE] -.054 [.03]; Pâ¯=â¯.045) and tended to relate to poorer performance in psychomotor speed (ß [SE] -.061 [.03]; Pâ¯=â¯.070). CONCLUSIONS: Serum insulin and insulin resistance may be independent predictors of cognitive performance 7 years later in elderly individuals without dementia. Randomized controlled trials are needed to determine this issue.
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Glucemia/metabolismo , Cognición , Disfunción Cognitiva/metabolismo , Resistencia a la Insulina , Insulina/metabolismo , Anciano , Anciano de 80 o más Años , Disfunción Cognitiva/epidemiología , Función Ejecutiva , Femenino , Finlandia/epidemiología , Humanos , Modelos Lineales , Estudios Longitudinales , Masculino , Memoria Episódica , Análisis Multivariante , Factores de RiesgoRESUMEN
INTRODUCTION: The 2-year Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) multidomain lifestyle intervention trial (NCT01041989) demonstrated beneficial effects on cognition. We investigated whether sociodemographics, socioeconomic status, baseline cognition, or cardiovascular factors influenced intervention effects on cognition. METHODS: The FINGER recruited 1260 people from the general Finnish population (60-77 years, at risk for dementia). Participants were randomized 1:1 to multidomain intervention (diet, exercise, cognition, and vascular risk management) and regular health advice. Primary outcome was change in cognition (Neuropsychological Test Battery z-score). Prespecified analyses to investigate whether participants' characteristics modified response to intervention were carried out using mixed-model repeated-measures analyses. RESULTS: Sociodemographics (sex, age, and education), socioeconomic status (income), cognition (Mini-Mental State Examination), cardiovascular factors (body mass index, blood pressure, cholesterol, fasting glucose, and overall cardiovascular risk), and cardiovascular comorbidity did not modify response to intervention (P-values for interaction > .05). CONCLUSIONS: The FINGER intervention was beneficial regardless of participants' characteristics and can thus be implemented in a large elderly population at increased risk for dementia.
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Disfunción Cognitiva/prevención & control , Demencia/prevención & control , Estilo de Vida Saludable , Anciano , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Cognición , Terapia Cognitivo-Conductual , Disfunción Cognitiva/epidemiología , Demencia/epidemiología , Terapia por Ejercicio , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Factores Socioeconómicos , Resultado del TratamientoRESUMEN
BACKGROUND: Physical activity may be beneficial for cognition, but the effect may vary depending on personal characteristics. METHODS: We investigated the associations between leisure-time physical activity (LTPA) from mid- to late life, the risk of dementia, and the role of body mass index, sex, and APOE in the CAIDE study during 28-year follow-up. Cognitive function of a random subsample was assessed at a mean age of 78.8 years (n = 1511), and dementia/Alzheimer's disease (AD) diagnoses were identified from national registers for the entire target population (n = 3559). RESULTS: Moderate (hazard ratio [HR], 1.46; 95% confidence interval [CI], 1.08-1.99) and low levels of midlife LTPA (HR, 1.39; 95% CI, 0.99-1.95) were associated with higher risk of dementia in comparison with the most active category. The benefits were more pronounced among men, overweight individuals, and APOE ε4 noncarriers. Maintaining high LTPA (HR, 0.16; 95% CI, 0.06-0.41) or increasing LTPA (HR, 0.19; 95% CI, 0.09-0.40) after midlife was associated with lower dementia risk. Similar results were observed for AD. CONCLUSIONS: The window of opportunity for preventive physical activity interventions may extend from midlife to older ages.
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Índice de Masa Corporal , Demencia , Actividades Recreativas/psicología , Actividad Motora/fisiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Planificación en Salud Comunitaria , Demencia/diagnóstico , Demencia/epidemiología , Demencia/psicología , Progresión de la Enfermedad , Femenino , Finlandia/epidemiología , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Neuroimagen , Pruebas Neuropsicológicas , Modelos de Riesgos Proporcionales , Escalas de Valoración Psiquiátrica , Factores de RiesgoRESUMEN
Coronary heart disease (CHD) has been linked with cognitive decline and dementia in several studies. CHD is strongly associated with blood pressure, but it is not clear how blood pressure levels or changes in blood pressure over time affect the relation between CHD and dementia-related pathology. The aim of this study was to investigate relations between CHD and cortical thickness, gray matter volume and white matter lesion (WML) volume on MRI, considering CHD duration and blood pressure levels from midlife to three decades later. The study population included 69 elderly at risk of dementia who participated in the Cardiovascular Risk Factors, Aging and Dementia (CAIDE) study. CAIDE participants were examined in midlife, re-examined 21 years later, and then after additionally 7 years (in total up to 30 years follow-up). MRIs from the second re-examination were used to calculate cortical thickness, gray matter and WML volume. CHD diagnoses were obtained from the Finnish Hospital Discharge Register. Linear regression analyses were adjusted for age, sex, follow-up time and scanner type, and additionally total intracranial volume in GM volume analyses. Adding diabetes, cholesterol or smoking to the models did not influence the results. CHD was associated with lower thickness in multiple regions, and lower total gray matter volume, particularly in people with longer disease duration (>10 years). Associations between CHD, cortical thickness and gray matter volume were strongest in people with CHD and hypertension in midlife, and those with CHD and declining blood pressure after midlife. No association was found between CHD and WML volumes. Based on these results, long-term CHD seems to have detrimental effects on brain gray matter tissue, and these effects are influenced by blood pressure levels and their changes over time.
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Corteza Cerebral/patología , Enfermedad Coronaria/complicaciones , Demencia/etiología , Sustancia Gris/patología , Sustancia Blanca/patología , Adulto , Anciano , Anciano de 80 o más Años , Envejecimiento , Demencia/patología , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Factores de RiesgoRESUMEN
OBJECTIVE: We investigated the association between late-life cynical distrust and incident dementia and mortality (mean follow-up times of 8.4 and 10.4 years, respectively) in the Cardiovascular Risk Factors, Aging and Dementia Study. METHODS: Cynical distrust was measured based on the Cook-Medley Scale and categorized into tertiles. Cognitive status was evaluated with a 3-step protocol including screening, clinical phase, and differential diagnostic phase. Dementia was diagnosed according to DSM-IV criteria. Complete data on exposure, outcome, and confounders were available from 622 persons (46 dementia cases) for the dementia analyses and from 1,146 persons (361 deaths) for the mortality analyses. Age, sex, systolic blood pressure, total cholesterol, fasting glucose, body mass index, socioeconomic background, smoking, alcohol use, self-reported health, and APOE genotype were considered as confounders. RESULTS: Cynical distrust was not associated with dementia in the crude analyses, but those with the highest level of cynical distrust had higher risk of dementia after adjusting for confounders (relative risk 3.13; 95% confidence interval [CI] 1.15-8.55). Higher cynical distrust was associated with higher mortality in the crude analyses (hazard ratio 1.40; 95% CI 1.05-1.87) but the association was explained by confounders (adjusted hazard ratio 1.19; 95% CI 0.86-1.61). CONCLUSIONS: Higher cynical distrust in late life was associated with higher mortality, but this association was explained by socioeconomic position, lifestyle, and health status. Association between cynical distrust and incident dementia became evident when confounders were considered. This novel finding suggests that both psychosocial and lifestyle-related risk factors may be modifiable targets for interventions. We acknowledge the need for larger replication studies.
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Envejecimiento , Actitud , Enfermedades Cardiovasculares/epidemiología , Demencia/epidemiología , Demencia/mortalidad , Estilo de Vida , Anciano , Consumo de Bebidas Alcohólicas , Índice de Masa Corporal , Trastornos del Conocimiento/etiología , Estudios de Cohortes , Planificación en Salud Comunitaria , Demencia/complicaciones , Femenino , Estado de Salud , Humanos , Incidencia , Masculino , Factores de Riesgo , Factores Sexuales , Fumar , Factores de TiempoRESUMEN
BACKGROUND: Many cardiovascular risk factors are shown to increase the risk of dementia and Alzheimer's disease (AD), but the impact of heart disease on later development of dementia is still unclear. OBJECTIVE: The aim of the study was to investigate the long-term risk of dementia and Alzheimer's disease (AD) related to midlife and late-life atrial fibrillation (AF), heart failure (HF), and coronary artery disease (CAD) in a population-based study with a follow-up of over 25 years. METHODS: Cardiovascular Risk Factors, Aging and Dementia (CAIDE) study includes 2000 participants who were randomly selected from four separate, population-based samples originally studied in midlife (1972, 1977, 1982, or 1987). Re-examinations were carried out in 1998 and 2005-2008. Altogether 1,510 (75.5%) persons participated in at least one re-examination, and 127 (8.4%) persons were diagnosed with dementia (of which 102 had AD). RESULTS: AF in late-life was an independent risk factor for dementia (HR 2.61, 95% CI 1.05-6.47; p = 0.039) and AD (HR 2.54, 95% CI 1.04-6.16; p = 0.040) in the fully adjusted analyses. The association was even stronger among the apolipoprotein E (APOE) ε4 non-carriers. Late-life HF, but not CAD, tended to increase the risks as well. Heart diseases diagnosed at midlife did not increase the risk of later dementia and AD. CONCLUSION: Late-life heart diseases increase the subsequent risk of dementia and AD. Prevention and effective treatment of heart diseases may be important also from the perspective of brain health and cognitive functioning.
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Enfermedad de Alzheimer/epidemiología , Fibrilación Atrial/epidemiología , Enfermedad de la Arteria Coronaria/epidemiología , Demencia/epidemiología , Insuficiencia Cardíaca/epidemiología , Factores de Edad , Anciano , Enfermedad de Alzheimer/genética , Apolipoproteína E4/genética , Fibrilación Atrial/genética , Estudios de Cohortes , Enfermedad de la Arteria Coronaria/genética , Demencia/genética , Femenino , Finlandia/epidemiología , Estudios de Seguimiento , Insuficiencia Cardíaca/genética , Humanos , Masculino , Riesgo , Factores de Riesgo , Factores SocioeconómicosRESUMEN
BACKGROUND: Obesity has been consistently associated with dementia. The role of certain risk factors of dementia may change during life, and the importance of having a life-course perspective has been acknowledged. OBJECTIVE: The aim of this study was to investigate the association of midlife and late-life body mass index (BMI) with late-life dementia/Alzheimer's disease (AD) and whether the association was independent of other obesity-related co-morbidities. METHODS: The association between midlife BMI (mean age 50.2, SD 6.0) and late-life BMI (mean age 71.2, SD 4.0) and incident dementia later in life (mean age 75.7, SD 5.0) were investigated among 1,304 participants of the longitudinal population-based Cardiovascular risk factors, Aging and Dementia (CAIDE) study, conducted in Eastern Finland. The duration of follow-up was 26 years. The diagnosis of dementia was based on DSM-IV criteria and the probable and possible AD on the NINCDS-ADRDA criteria. RESULTS: Higher midlife BMI was associated with higher risk of incident dementia (adjusted HR, 95% CI 1.07, 1.00-1.14). However, decrease in BMI from midlife to late-life was associated with higher risk of dementia (1.14, 1.03-1.25 for one-unit decrease) and AD (1.20, 1.09-1.33). High late-life BMI was associated with lower risk of AD (0.89, 0.81-0.98) but the association with dementia was less evident (0.94, 0.86-1.03). CONCLUSION: Higher midlife BMI is related to higher risk of dementia and AD, independently of obesity-related risk factors and co-morbidities. Steeper decrease of BMI and low late-life BMI are associated with higher risk of dementia and AD. These findings highlight the importance of life-course perspective when assessing the association between BMI and cognition.
Asunto(s)
Envejecimiento , Índice de Masa Corporal , Demencia/epidemiología , Obesidad/epidemiología , Edad de Inicio , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Planificación en Salud Comunitaria , Femenino , Humanos , Masculino , Obesidad/complicaciones , Factores de RiesgoRESUMEN
BACKGROUND: Previous research indicates that persons with chronic obstructive pulmonary disease (COPD) and asthma may have more cognitive impairment compared to persons without these diseases. However, there are no previous studies regarding long-term effects of these diseases on the risk of clinically diagnosed mild cognitive impairment (MCI) and dementia. We examined the association between midlife and late-life self-reported COPD and asthma and the lifelong risk of cognitive impairment (MCI/dementia) in a population-based study with a follow-up of over 25 years. METHODS: Cardiovascular Risk Factors, Aging and Dementia (CAIDE) study includes 2000 participants who were randomly selected from four separate, population-based samples originally studied in midlife (1972, 1977, 1982 or 1988). Re-examinations were carried out in 1998 and 2005-8 (N=1511, 75.6 %) during which 172 persons were diagnosed with MCI and 117 with dementia. RESULTS: Midlife COPD (HR 1.85, 95% CI 1.05 - 3.28), asthma (HR 1.88, 95% CI 0.77 - 4.63) and both pulmonary diseases combined (HR 1.94, 95% CI 1.16 - 3.27) increased the later risk of cognitive impairment even after full adjustments. However, pulmonary diseases diagnosed later in life seemed to be inversely related to cognitive impairment (fully adjusted model for both pulmonary diseases combined HR 0.42, 95% CI 0.19 - 0.93). CONCLUSIONS: In this population-based study, with more than 25 years of follow-up, midlife COPD and asthma were associated with an almost two-fold risk of MCI and dementia later in life. Pulmonary diseases diagnosed later in life seemed to have an inverse relationship with cognitive impairment probably reflecting survival bias.
Asunto(s)
Asma/epidemiología , Disfunción Cognitiva/epidemiología , Demencia/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Adulto , Anciano , Enfermedades Cardiovasculares/complicaciones , Disfunción Cognitiva/complicaciones , Estudios de Cohortes , Planificación en Salud Comunitaria , Demencia/complicaciones , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Factores de Riesgo , AutoinformeRESUMEN
BACKGROUND: Smoking is a risk factor for several life-threatening diseases, but its long-term association with dementia is controversial and somewhat understudied. Our objective was to investigate the long-term association of amount of smoking in middle age on the risk of dementia, Alzheimer disease (AD), and vascular dementia (VaD) several decades later in a large, diverse population. METHODS: We analyzed prospective data from a multiethnic population-based cohort of 21,123 members of a health care system who participated in a survey between 1978 and 1985. Diagnoses of dementia, AD, and VaD made in internal medicine, neurology, and neuropsychology were collected from January 1, 1994, to July 31, 2008. Multivariate Cox proportional hazards models were used to investigate the association between midlife smoking and risk of dementia, AD, and VaD. RESULTS: A total of 5367 people (25.4%) were diagnosed as having dementia (including 1136 cases of AD and 416 cases of VaD) during a mean follow-up period of 23 years. Results were adjusted for age, sex, education, race, marital status, hypertension, hyperlipidemia, body mass index, diabetes, heart disease, stroke, and alcohol use. Compared with nonsmokers, those smoking more than 2 packs a day had an elevated risk of dementia (adjusted hazard ratio [HR], 2.14; 95% CI, 1.65-2.78), AD (adjusted HR, 2.57; 95% CI, 1.63-4.03), and VaD (adjusted HR, 2.72; 95% CI, 1.20-6.18). CONCLUSIONS: In this large cohort, heavy smoking in midlife was associated with a greater than 100% increase in risk of dementia, AD, and VaD more than 2 decades later. These results suggest that the brain is not immune to long-term consequences of heavy smoking.
Asunto(s)
Enfermedad de Alzheimer/epidemiología , Demencia Vascular/epidemiología , Fumar/epidemiología , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/etiología , Estudios de Cohortes , Demencia/epidemiología , Demencia/etiología , Demencia Vascular/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Factores de Riesgo , Fumar/efectos adversosRESUMEN
Alzheimer's disease is the most common cause of dementia. Early diagnosis of diseases leading to dementia is cost-effective. However, early diagnosis of Alzheimer's disease may be difficult and should not be based on exclusion of other reasons for dementia. A decreased CSF amyloid beta-peptide-42 level together with elevated tau or phosphorylated tau levels can differentiate patients with AD from control subjects or patients with other neurologic conditions with relatively high accuracy. We evaluated the use of these biomarkers in 452 patient cohort during 2005-2007 in clinical practice. Cerebrospinal fluid biomarkers seem to be useful especially to confirm Alzheimer's disease diagnosis.