People's interest in brain health testing: Findings from an international, online cross-sectional survey.

Brain health entails mental wellbeing and cognitive health in the absence of brain disorders. The past decade has seen an explosion of tests, cognitive and biological, to predict various brain conditions, such as Alzheimer's Disease. In line with these current developments, we investigated people's willingness and reasons to-or not to-take a hypothetical brain health test to learn about risk of developing a brain disease, in a cross-sectional multilanguage online survey. The survey was part of the Global Brain Health Survey, open to the public from 4th June 2019 to 31st August 2020. Respondents were largely recruited via European brain councils and research organizations. 27,590 people responded aged 18 years or older and were predominantly women (71%), middle-aged or older (>40 years; 83%), and highly educated (69%). Responses were analyzed to explore the relationship between demographic variables and responses. Results: We found high public interest in brain health testing: over 91% would definitely or probably take a brain health test and 86% would do so even if it gave information about a disease that cannot be treated or prevented. The main reason for taking a test was the ability to respond if one was found to be at risk of brain disease, such as changing lifestyle, seeking counseling or starting treatment. Higher interest in brain health testing was found in men, respondents with lower education levels and those with poor self-reported cognitive health. Conclusion: High public interest in brain health and brain health testing in certain segments of society, coupled with an increase of commercial tests entering the market, is likely to put pressure on public health systems to inform the public about brain health testing in years to come.

Smoking and Obesity as Risk Factors in Frontotemporal Dementia and Alzheimer's Disease: The HUNT Study.

BACKGROUND: Few studies have assessed smoking and obesity together as risk factors for frontotemporal dementia (FTD) and Alzheimer's disease (AD). OBJECTIVE: To study smoking and obesity as risk factors for FTD and AD. METHODS: Ninety patients with FTD and 654 patients with AD were compared with 116 cognitively healthy elderly individuals in a longitudinal design with 15-31 years between measurements of risk factors before the dementia diagnosis. RESULTS: There were no associations between smoking and FTD (p = 0.218; odds ratio [OR]: 0.990; 95% confidence interval [CI]: 0.975-1.006). There were significant associations between obesity and FTD (p = 0.049; OR: 2.629; 95% CI: 1.003-6.894). There were significant associations between both smoking (p = 0.014; OR: 0.987; 95% CI: 0.977-0.997) and obesity (p = 0.015; OR: 2.679; 95% CI: 1.211-5.928) and AD. CONCLUSION: Our findings suggest that obesity is a shared risk factor for FTD and AD, while smoking plays various roles as a risk factor for FTD and AD.

Risk factors for frontotemporal dementia. / Risikofaktorer for frontotemporal demens.

BAKGRUNN: Risikofaktorer for frontotemporal demens er lite kartlagt. Formålet med denne artikkelen var å gi en oppdatert oversikt over modifiserbare risikofaktorer for frontotemporal demens og vurdere kunnskapsgrunnlaget for kliniske anbefalinger for å redusere risiko for sykdommen. KUNNSKAPSGRUNNLAG: Det ble utført søk i basene PsychInfo, Embase, PubMed og Cochrane i perioden mai 2016-april 2017. Søket ga totalt 137 artikler. 101 artikler ble ekskludert fordi de kun omhandlet genetiske aspekter ved frontotemporal demens og ikke modifiserbare risikofaktorer. Etter å ha lest 36 artikler i fulltekst inkluderte vi 12 artikler som enten var oversiktsartikler eller originalstudier. RESULTATER: Enkelte studier viste sammenheng mellom modifiserbare risikofaktorer og utvikling av frontotemporal demens. I én studie fant man at diabetes ga økt risiko. Tre studier viste at hodetraume kan gi økt risiko for frontotemporal demens og at forekomsten av traumatisk hodeskade var signifikant høyere hos pasienter med frontotemporal demens enn andre former for demens. Autoimmun sykdom kan være forbundet med økt risiko for primær progressiv afasi, en undergruppe av frontotemporal demens. FORTOLKNING: Litteraturen indikerte sammenheng mellom diabetes, hodetraume, autoimmun sykdom og frontotemporal demens. Det finnes per i dag ikke tilstrekkelig kunnskap for å fremme anbefalinger om livsstilsendringer for å forebygge frontotemporal demens på befolkningsnivå.

Anxiety and Depression as Risk Factors in Frontotemporal Dementia and Alzheimer's Disease: The HUNT Study.

Background: The roles of both anxiety and depression as risk factors for frontotemporal dementia (FTD) and Alzheimer's disease (AD) have not been previously investigated together. Objective: To study anxiety and depression as independent risk factors for FTD and AD. Methods: Eighty-four patients with FTD and 556 patients with AD were compared with 117 cognitively healthy (CH), elderly individuals. Both cases and controls were participants in the second Health Study of Nord-Trøndelag (HUNT2) from 1995 to 1997, in which depression and anxiety were assessed with the Hospital Anxiety and Depression Scale (HADS). Results: Significant associations were found between anxiety and FTD and between depression and AD. A significantly increased risk of developing FTD was observed in patients who had reported anxiety on the HADS (p = 0.017) (odds ratio [OR]: 2.947, 95% confidence interval [CI]: 1.209-7.158) and a significantly increased risk of developing AD was observed in patients who had reported depression on the HADS (p = 0.016) (OR: 4.389, 95% CI: 1.311-14.690). Conclusion: Our study findings suggest that anxiety and depression may play different roles as risk factors for FTD and AD.

Frontotemporal Dementia: An Updated Clinician's Guide.

Today, frontotemporal dementia (FTD) remains one of the most common forms of early-onset dementia, that is, before the age of 65, thus posing several diagnostic challenges to clinicians since symptoms are often mistaken for psychiatric or neurological diseases causing a delay in correct diagnosis, and the majority of patients with FTD present with symptoms at ages between 50 and 60. Genetic components are established risk factors for FTD, but the influence of lifestyle, comorbidity, and environmental factors on the risk of FTD is still unclear. Approximately 40% of individuals with FTD have a family history of dementia but less than 10% have a clear autosomal dominant pattern of inheritance. Lack of insight is often an early clue to FTD. A tailored treatment option at an early phase can mitigate suffering and improve patients' and caregivers' quality of life.

Association Between Random Measured Glucose Levels in Middle and Old Age and Risk of Dementia-Related Death.

OBJECTIVES: To investigate the association between random measured glucose levels in middle and old age and dementia-related death. DESIGN: Population-based cohort study. SETTING: Norwegian Counties Study (middle-aged individuals; 35-49) and Cohort of Norway participants (older individuals; 65-80). PARTICIPANTS: Individuals without (n=74,630) and with (n=3,095) known diabetes mellitus (N=77,725); 67,865 without and 2,341 with diabetes mellitus were included in the complete case analyses (nonmissing for all included covariates), of whom 1,580 without and 131 with diabetes mellitus died from dementia-related causes. MEASUREMENTS: Dementia-related death was ascertained according to the Norwegian Cause of Death Registry. Cox regression was used to assess the relationship between random glucose levels (nonfasting) in individuals without and with diabetes mellitus and dementia-related death. Education, smoking, cardiovascular disease, body mass index, cholesterol, blood pressure, and physical activity were adjusted for. RESULTS: Individuals without diabetes mellitus at midlife with glucose levels between 6.5 and 11.0 mmol/L had a significantly greater risk of dementia-related death than those with levels less than 5.1 mmol/L (hazard ratio=1.32, 95% confidence interval=1.04-1.67) in a fully adjusted model. A dose-response relationship (P=.02) was observed. No significant association between high glucose levels in individuals aged 65 to 80 and dementia-related death was detected. CONCLUSION: High random glucose levels measured in middle-aged but not older age persons without known diabetes mellitus were associated with greater risk of dementia-related death up to four decades later.

Association of psychological distress late in life and dementia-related mortality.

OBJECTIVE: It is not fully understood how subjective feelings of psychological distress prognosticate dementia. Our aim was to investigate the association between self-reported psychological distress and risk of dementia-related mortality. METHOD: We included 31,043 eligible individuals between the ages of 60 and 80 years, at time of examination, from the CONOR (Cohort of Norway) database. They were followed for a period of 17.4 years (mean 11.5 years). The CONOR Mental Health Index, a seven-item self-report scale was used. A cut-off score equal to or above 2.15 on the scale denoted psychological distress. Cox regression was used to assess the association between psychological distress and risk of dementia-related mortality. RESULTS: Total number of registered deaths was 11,762 and 1118 (9.5%) were classified as cases of dementia-related mortality. We found that 2501 individuals (8.1%) had psychological distress, of these, 119 (10.6%) had concomitant dementia-related mortality. Individuals with psychological distress had an increased risk of dementia-related mortality HR = 1.52 (95% confidence interval (CI) 1.25-1.85) after adjusting for age, gender and education. The association remained significant although attenuated when implemented in a full adjusted model, including general health status, smoking, obesity, hypertension, diabetes and history of cardiovascular disease; hazard ratio, HR = 1.30 (95% CI 1.06-1.59). CONCLUSION: Our results indicate that psychological distress in elderly individuals is associated with increased risk of dementia-related mortality. Individuals at increased risk of dementia may benefit from treatments or interventions that lessen psychological distress, but this needs to be confirmed in future clinical studies.

Interaction of Apolipoprotein E Genotypes, Lifestyle Factors and Future Risk of Dementia-Related Mortality: The Cohort of Norway (CONOR).

BACKGROUND/AIMS: Our aims were two-fold: firstly, to investigate the association and interaction between apolipoprotein E (ApoE), lifestyle risk factors and dementia-related mortality and, secondly, to examine if using dementia-related mortality yielded comparable risk estimates for the ApoE genotypes as reported in studies using a clinical dementia diagnosis as the end point. METHODS: We used a nested case-control study with 561 cases drawn from dementia deaths in the Cohort of Norway (CONOR) and 584 alive controls. RESULTS: ApoE ε4 carriers were at increased risk of dementia-related mortality compared to noncarriers [odds ratio (OR) 2.46, 95% confidence interval (CI) 1.93-3.13], and ε4 homozygotes were at particularly high risk (OR 7.86, 95% CI 3.80-13.8), while the ε2 type was associated with a lower risk. The highest risk of dementia-related mortality was found among ε4 carriers with more lifestyle risk factors (ε4 carriers who were smokers, hypertensive, physically inactive and diabetics) versus ε4 noncarriers without lifestyle risk factors (OR 15.4, 95% CI 4.37-52.4). The increased risk was additive, not multiplicative. CONCLUSIONS: Ensuring a healthy lifestyle is important to be able to prevent dementia in populations at large, but especially for ε4 carriers. Using dementia mortality gives comparable results for the ApoE-dementia association as studies using clinical dementia diagnoses.

Associations between Physical Activity in Old Age and Dementia-Related Mortality: A Population-Based Cohort Study.

BACKGROUND: Findings from the literature vary in relation to whether physical activity brings about less cognitive decline in old age. The present study investigated self-reported levels of physical activity in old age and its association with the risk of dementia-related mortality. METHODS: We included data from 31,086 subjects, between 65 and 80 years old, from the CONOR (Cohort of Norway) database. Cox regression analysis was used to estimate the risk of association. RESULTS: Taking part in 'light' (not causing perspiration or panting) activities of <3 h per week was associated with a decreased risk of dementia-related mortality, with a hazard ratio (HR) of 0.74 and a 95% confidence interval (CI) of 0.62-0.88, and of >3 h per week, with an HR of 0.61 and a 95% CI of 0.51-0.73. When taking part in 'hard' (causing perspiration or panting) activities, a similar risk (HR = 0.56; 95% CI 0.43-0.72) was observed for >3 h per week. Interestingly, the highest reduction in risk was seen for 'hard' activities of <3 h per week (HR = 0.50; 95% CI 0.41-0.61). CONCLUSION: Physical activity during leisure time in old age was associated with a lower risk of dementia-related mortality when compared to inactive individuals.