Lung function and risk of incident dementia: A prospective cohort study of 431,834 individuals.

BACKGROUND: Whether lung function prospectively affects cognitive brain health independent of their overlapping factors remains largely unknown. This study aimed to investigate the longitudinal association between decreased lung function and cognitive brain health and to explore underlying biological and brain structural mechanisms. METHODS: This population-based cohort included 43,1834 non-demented participants with spirometry from the UK Biobank. Cox proportional hazard models were fitted to estimate the risk of incident dementia for individuals with low lung function. Mediation models were regressed to explore the underlying mechanisms driven by inflammatory markers, oxygen-carrying indices, metabolites, and brain structures. FINDINGS: During a follow-up of 3,736,181 person-years (mean follow-up 8.65 years), 5,622 participants (1.30 %) developed all-cause dementia, which consisted of 2,511 Alzheimer's dementia (AD) and 1,308 Vascular Dementia (VD) cases. Per unit decrease in lung function measure was each associated with increased risk for all-cause dementia (forced expiratory volume in 1 s [liter]: hazard ratio [HR, 95 %CI], 1.24 [1.14-1.34], P = 1.10 × 10-07; forced vital capacity [liter]: 1.16 [1.08-1.24], P = 2.04 × 10-05; peak expiratory flow [liter/min]: 1.0013 [1.0010-1.0017], P = 2.73 × 10-13). Low lung function generated similar hazard estimates for AD and VD risks. As underlying biological mechanisms, systematic inflammatory markers, oxygen-carrying indices, and specific metabolites mediated the effects of lung function on dementia risks. Besides, brain grey and white matter patterns mostly affected in dementia were substantially changed with lung function. INTERPRETATION: Life-course risk for incident dementia was modulated by individual lung function. Maintaining optimal lung function is useful for healthy aging and dementia prevention.

Risk of seizures and subclinical epileptiform activity in patients with dementia: A systematic review and meta-analysis.

BACKGROUND: Seizures and subclinical epileptiform activity are common yet easily overlooked among demented patients. We aimed to investigate their epidemiological characteristics in patients with dementia from various aspects. METHODS: We retrieved relevant observational studies from PubMed and Embase Library until March 2021. Pooled estimate effects were calculated using random-effects models. This study is registered with PROSPERO, number CRD42020200949. RESULTS: Of the 19144 identified studies, 27 were eligible for inclusion. The pooled period prevalence rates of seizures were 4.86% (95%CI: 3.43-6.51%), 2.68% (95%CI: 2.13-3.28%), 2.81% (95%CI: 2.02-3.71%）and 7.13% (95%CI: 2.67-13.14%) among patients with Alzheimer's disease (AD), Dementia of Lewy Body (DLB), Frontotemporal dementia (FTD) and Vascular dementia (VaD), respectively. The pooled incidence rate of seizures was [8.4 (95%CI: 4.2-12.7) per 1000 person-years] in AD patients. And the pooled relative risk of seizures in patients with AD was 3.35 (95%CI: 2.69-4.19). Besides, the pooled cumulative incidence rate and prevalence rate of subclinical epileptiform activity among AD patients were [21.41% (95%CI: 0.001-63.60%)] and 9.73% (95%CI: 0.26-28.38%), respectively. CONCLUSIONS: The accurate rates of seizures and subclinical epileptiform activities in the four major dementia types are high. Besides, patients with AD are likely at a higher risk of seizures.

Social Isolation, Social Interaction, and Alzheimer's Disease: A Mendelian Randomization Study.

BACKGROUND: Social isolation and social interaction have been suggested to be associated with Alzheimer's disease. However, the causality cannot be unambiguously assessed as traditional epidemiological methods are easily subject to unmeasured confounders and potential bias. OBJECTIVE: To examine bidirectional relationships between social isolation, social interaction, and Alzheimer's disease using Mendelian randomization method for assessing potential causal inference. METHODS: This bidirectional two-sample Mendelian randomization study used independent genetic variants associated with social isolation and social interaction (n = 302,567-487,647), and Alzheimer's disease (n = 455,258). MR analyses were performed using the inverse-variance-weighted (IVW) as the main MR analytical method to estimate the causal effect. For sensitivity analyses, we applied weighted median, MR Egger to further assess the credibility of the causal effect. RESULTS: Of the five types of social engagement examined in our study, only one showed evidence of an association with the risk of Alzheimer's disease. Attendance at a gym or sports club (IVW OR per SD change: 0.670; 95% CI: 0.463-0.970; p = 0.034) was inversely associated with the risk of Alzheimer's disease. We also found that AD may reduce the attendance at religious group (IVW OR per SD change: 1.017; 95% CI: 1.005-1.030; p = 0.004). CONCLUSION: This study suggests that regular attendance at a gym or sports club is causally associated with reduced risk of Alzheimer's disease. Further studies are warranted to elucidate potential mechanisms.

A Novel Technique of Long-Segment Tracheal Repair With Extended Bronchial Flap of Right Upper and Main Bronchus Plus Tracheoplasty.

Long-segment tracheal resection and repair pose a great challenge. We present a successful case of long-segment tracheal defect repair with extended bronchial flap of the right upper and main bronchus, together with a tracheoplastic method. This is a novel technique for repairing a large tracheal defect with an extended pedicled bronchial flap in specific situations.