Article

Cognitive activity, education and socioeconomic status as preventive factors for mild cognitive impairment and Alzheimer's disease

March 2012
Psychiatry Research 196(1):90-5

DOI:10.1016/j.psychres.2011.11.012

Source
PubMed

Authors:

Pablo Toro

Pontifical Catholic University of Chile

Johannes Schröder

Heidelberg University

Growing epidemiological evidence suggests that premorbid participation in cognitive leisure activities (CLA) reduces the risk of dementia by increasing cognitive reserve. We investigated the differential effect of CLA, education, and socioeconomic status (SES) on the development of mild cognitive impairment (MCI) and Alzheimer's disease (AD). Participants in the prospective population-based ILSE study (*1930-1932; 12-year follow-up) were examined in three examination waves (t1:1993/94; t2:1997/98; t3:2005/07). In total, 381 subjects of the original cohort (n=500) were re-examined at t3. Of these subjects 29% received the diagnosis of MCI and 7% of AD. Subjects participated in a thorough psychogeriatric examination and neuropsychological testing. Moreover, they took part in a detailed autobiographical interview and completed questionnaires including socio-demographic data and current frequency of participation in CLA. Subjects who were highly cognitively active at t1 had a significantly reduced risk of developing MCI/AD at t3 (scores adjusted for education, SES, gender, and depressive symptoms). Additionally, high education and high SES separately reduced the risk of MCI and AD. Our results confirm the hypothesis that a high level of CLA acts as a protective factor against the development of MCI and AD by increasing cognitive reserve. This effect is not accounted for by important potential confounders.

Geographic disparities in Alzheimer's disease and related dementia mortality in the US: Comparing impacts of place of birth and place of residence

Article

Full-text available

Sep 2024

Objective This study investigates geographic variations in ADRD mortality in the US. By considering both state of residence and state of birth, we aim to discern the relative importance of these geospatial factors. Methods We conducted a secondary data analysis of the National Longitudinal Mortality Study (NLMS), that has 3.5 million records from 1973 to 2011 and over 0.5 million deaths. We focused on individuals born in or before 1930, tracked in NLMS cohorts from 1979 to 2000. Employing multi-level logistic regression, with individuals nested within states of residence and/or states of birth, we assessed the role of geographical factors in ADRD mortality variation. Results We found that both state of birth and state of residence account for a modest portion of ADRD mortality variation. Specifically, state of residence explains 1.19% of the total variation in ADRD mortality, whereas state of birth explains only 0.6%. When combined, both state of residence and state of birth account for only 1.05% of the variation, suggesting state of residence could matter more in ADRD mortality outcomes. Conclusion Findings of this study suggest that state of residence explains more variation in ADRD mortality than state of birth. These results indicate that factors in later life may present more impactful intervention points for curbing ADRD mortality. While early-life environmental exposures remain relevant, their role as primary determinants of ADRD in later life appears to be less pronounced in this study.

Poor periodontal health is linked to impaired cognitive performance in older people: A cross-sectional study

Preprint

Full-text available

Jun 2023

Background At present, there is no cure for dementia, and most available treatments have shown marginal or no effect. This fact makes it crucial to identify factors that increase the risk of cognitive decline in the population. Evidence suggests that poor periodontal health may be one of those factors; nonetheless, to ascertain this possibility, it is necessary to account for the influence of education, as it is frequently the determining factor that explains the association between a risk factor and cognitive impairment. Therefore, this study aimed to determine whether poor periodontal health is associated with impaired cognitive performance in older people from an agricultural community in Chile, independent of education. Methods A cross-sectional study was conducted with the entire universe of participants older than 60 years from the MAUCO cohort in 2015. The exposure of interest was periodontal health status assessed through a proxy measure based on gum appearance (color) and bleeding, and individuals were categorized into three groups: healthy periodontium, signs of possible disease, and unhealthy periodontium. The dependent variable was cognitive performance evaluated using the ACE-R test. The confounding effect generated by sociodemographic factors was controlled through regression models: linear regression with the score obtained in the ACE-R test and multinomial regression for normal cognition, cognitive impairment, and dementia as outcomes. Results The study included 2,716 participants with a mean age of 65.7 ± 4 years, of whom 52% were women and 63% had a low educational level. Unhealthy periodontium was observed in 10.8% of the individuals, while 17.6% had cognitive impairment or dementia. People with an unhealthy periodontium scored two points lower on the ACE-R test and were almost twice as likely to have dementia (OR 1.86 95% CI 1.07–3.25) than those with periodontal health, regardless of age, sex, and educational level. Conclusion Older people with unhealthy periodontium seem to have worse cognitive performance and a higher possibility of suffering from dementia than those with healthy periodontium, regardless of sociodemographic factors. Education does not explain this outcome.

An explainable machine learning based prediction model for Alzheimer's disease in China longitudinal aging study

Article

Full-text available

Nov 2023

Alzheimer's disease (AD) is the most common cause of dementia. Accurate prediction and diagnosis of AD and its prodromal stage, i.e., mild cognitive impairment (MCI), is essential for the possible delay and early treatment for the disease. In this paper, we adopt the data from the China Longitudinal Aging Study (CLAS), which was launched in 2011, and includes a joint effort of 15 institutions all over the country. Four thousand four hundred and eleven people who are at least 60 years old participated in the project, where 3,514 people completed the baseline survey. The survey collected data including demographic information, daily lifestyle, medical history, and routine physical examination. In particular, we employ ensemble learning and feature selection methods to develop an explainable prediction model for AD and MCI. Five feature selection methods and nine machine learning classifiers are applied for comparison to find the most dominant features on AD/MCI prediction. The resulting model achieves accuracy of 89.2%, sensitivity of 87.7%, and specificity of 90.7% for MCI prediction, and accuracy of 99.2%, sensitivity of 99.7%, and specificity of 98.7% for AD prediction. We further utilize the SHapley Additive exPlanations (SHAP) algorithm to visualize the specific contribution of each feature to AD/MCI prediction at both global and individual levels. Consequently, our model not only provides the prediction outcome, but also helps to understand the relationship between lifestyle/physical disease history and cognitive function, and enables clinicians to make appropriate recommendations for the elderly. Therefore, our approach provides a new perspective for the design of a computer-aided diagnosis system for AD and MCI, and has potential high clinical application value.

Memory self-efficacy and working memory

Article

Full-text available

Sep 2023

Dementia affects multiple aspects of cognitive functioning, including working memory and executive functioning. Memory self-efficacy (MSE) has previously been related to episodic memory performance and to executive functioning, but little research has examined the relations between MSE and working memory. United States older adults (N = 197) were recruited via MTurk to complete an MSE questionnaire before completing a digit span working memory task. Hierarchical regression results revealed that the model accounted for a significant amount of variance in working memory performance after statistically controlling for several covariates, F(11, 179) = 4.94, p < .001, adjusted R2 = .19. MSE explained a large and unique portion of variance (B = 1.02, SE = 0.17, p < .001). Based on our findings, one's beliefs about their memory are positively associated with their working memory performance. These novel findings provide support for neuropsychologists to consider using MSE measures and utilizing MSE interventions.

Asociación entre nivel educacional y sospecha de deterioro cognitivo en personas mayores chilenas: resultados de la Encuesta Nacional Association between educational level and suspicion of cognitive imparirment in Chilean older people

Article

Full-text available

Jan 2016

Asociación entre nivel educacional y sospecha de deterioro cognitivo en personas mayores chilenas: resultados de la Encuesta Nacional de Salud 2016-2017

Article

Full-text available

May 2023
REV MED CHILE

Background: A low education level has been associated with cognitive impairment in older adults. Aim: To determine the association between educational attainment and suspicion of cognitive imparirment in older Chilean population. Material and Methods: Data from 2,005 adults aged ≥ 60 years assessed during 2016-2017 Chilean National Health Survey were included. Education was self-reported and categorized as primary: ≤ 8 years; secondary: 9 to 12 years and beyond secondary: > 12 years. suspicion of cognitive imparirment was assessed with the Mini-Mental questionnaire. Results: Men and women with low education attainment had a higher prevalence of cognitive impairment (33% [95% confidence intervals (CI): 24; 41] and 27% [95% CI: 21; 33], respectively). Men who reported less schooling (≤ 8 years) were more likely to be at risk of suspicion of cognitive imparirment (Odds ratio (OR): 4.53 [95% CI: 1.10, 18.62]) compared to their peers. Women showed a substantially higher magnitude of association than men. The probability of suspicion of cognitive imparirment increased 9-times (OR: 9.96 [95% CI: 1.24; 79.6]) for 9-12 years and 18-times for ≤ 8 years of education (OR: 18.8 [95% CI: 2.42; 146.1]) compared to women with higher education. Conclusions: Older adults with low education attainment had an increased likelihood of developing suspicion of cognitive imparirment. However, the risk differs by sex, being higher in women than men.

Structural Cerebral Correlates of Perplexity: Exploring a Linguistic Marker in Cognitive Aging

Article

Full-text available

Mar 2025

Language changes are among the earliest indicators of cognitive decline in aging. Perplexity, a linguistic measure derived from information theory that quantifies speech predictability, has emerged as a potential marker for detecting early cognitive changes. However, its underlying neural substrates remain unclear. This study investigated the structural brain correlates of perplexity in 38 elderly participants (26 cognitively healthy, 12 with mild cognitive impairment) using magnetic resonance imaging (MRI). Perplexity was computed automatically from autobiographical interviews using single‐word (1‐g) and word‐pair (2‐g) models. Voxel‐based morphometry analyses, adjusted for total intracranial volume, sex, and education, revealed distinct associations between perplexity measures and regional gray matter volume. Region‐of‐interest analyses confirmed significant positive correlations between 1‐g perplexity and left middle temporal gyrus volume as well as between 2‐g perplexity and left precuneus. These findings suggest that perplexity reflects both linguistic processing and autobiographical memory, as evidenced by its associations with language‐relevant temporal regions and memory‐related precuneus. This study provides initial insights into the neural basis of perplexity as a measure that captures both linguistic and content‐related aspects of language production in cognitive aging.

Development and validation of a dynamic nomogram for predicting cognitive impairment risk in older adults with dentures: analysis from CHARLS and CLHLS data

Article

Full-text available

Feb 2025
BMC Geriatr

Background and aims Cognitive impairment is a common issue among older adults, with denture use identified as a potential, easily recognizable clinical risk factor. However, the link between denture wear and cognitive decline in older Chinese adults remains understudied. This study aimed to develop and validate a dynamic nomogram to predict the risk of cognitive impairment in community-dwelling older adults who wear dentures. Methods We selected 2066 elderly people with dentures from CHARLS2018 data as the development and internal validation group and 3840 people from CLHLS2018 as the external validation group. Develop and treat the concentrated unbalanced data with the synthetic minority oversampling technique, select the best predictors with the LASSO regression ten-fold cross-validation method, analyze the influencing factors of cognitive impairment in the elderly with dentures using Logistic regression, and construct a nomogram. Subject operating characteristic curves, sensitivity, specificity, accuracy, precision, F1 score, calibration curve, and decision curve were used to evaluate the validity of the model in terms of identification, calibration, and clinical validity. Results We identified five factors (age, residence, education, instrumental activities of daily living, and depression) to construct the nomogram. The area under the curve of the prediction model was 0.854 (95%CI 0.839–0.870) in the development set, 0.841 (95%CI 0.805–0.877) in the internal validation set, and 0.856 (95%CI 0.838–0.873) in the external validation set. Calibration curves indicated significant agreement between predicted and actual values, and decision curve analysis demonstrated valuable clinical application. Conclusions Five risk factors, including age, place of residence, education, instrumental activities of daily living, and depression level, were selected as the final nomogram to predict the risk of cognitive impairment in elderly denture wearers. The nomogram has acceptable discrimination and can be used by healthcare professionals and community health workers to plan preventive interventions for cognitive impairment among older denture-wearing populations.

Augmenting Cognitive Function in the Elderly with Mild Cognitive Impairment Using Probiotic Lacticaseibacillus rhamnosus CBT-LR5: A 12-Week Randomized, Double-Blind, Parallel-Group Non-Comparative Study

Article

Full-text available

Feb 2025

Background: Probiotics have been shown to enhance cognitive function in individuals with mild cognitive impairment (MCI), but their efficacy varies, depending on the strain and dosage. Objectives: Clinical investigations are crucial to confirm their safety, efficacy, and mechanism of action. This study was designed to assess the effective dosage, safety, and efficacy of MH-Pro, a test product containing Lacticaseibacillus rhamnosus CBT-LR5 (LR5) and skim milk (non-fat dry milk), in improving cognitive function and related physiological changes in older adults suspected of MCI over 12 weeks. Methods: In total, 20 participants (mean age: 68.9 years) were randomly assigned in a 1:1 ratio to either a low-dose group (1 × 10¹⁰ CFU LR5 with 1622 mg) or a high-dose group (1 × 10¹⁰ CFU LR5 with 4055 mg skim milk) in a double-blind, parallel-group clinical trial. Results: After 12 weeks, the low-dose group showed significant improvements in the MOCA-K subdomains, specifically in naming (p = 0.01) and delayed recall (p = 0.003). Additionally, levels of amyloid-β1 40/42 in the blood significantly decreased (p = 0.03) following supplementation in the low-dose group. The high-dose group exhibited significant improvement in orientation (p = 0.05). Moreover, overall cognitive enhancement was observed in the low-dose group (p = 0.003), while the high-dose group showed a trend toward improvement (p = 0.06). Fecal analysis revealed significant changes in bacterial composition, with an increase in Lacticaseibacillus after 12 weeks of MH-Pro consumption. Together, these findings provide foundational evidence suggesting that MH-Pro supplementation may serve as a potential intervention for enhancing cognitive function through gut–brain axis pathways in the elderly population. However, given the small sample size and the predominance of female participants, the impact of the outcome may be limited. Further large-scale studies are necessary to validate these preliminary results. Conclusions: This study provides foundational evidence to recognize the use of LR5 and skim milk to prepare a probiotic supplement that enhances cognitive function in the aging population.

Mild cognitive impairment cases affect the predictive power of Alzheimers disease diagnostic models using routine clinical variables

Preprint

Full-text available

Feb 2025

Diagnostic models using primary care routine clinical variables have been limited in their ability to identify Alzheimers disease (AD) patients. In this study we sought to better understand the effect of mild cognitive impairment (MCI) on the predictive performance of AD diagnostic models. We sourced data from the Alzheimers Disease Neuroimaging Initiative (ADNI) cohort. CatBoost was used to assess the utility of routine clinical variables that are accessible to primary care physicians, such as hematological and blood tests and medical history, in multiclass classification between healthy controls, MCI, and AD. Our results indicated that MCI indeed affected the predictive performance of AD diagnostic models. Of three subgroups of MCI that we found, this finding was driven by a subgroup of MCI patients that likely have prodromal AD. Future research should focus on distinguishing MCI from prodromal AD as the utmost priority for improving translational AD diagnostic models for primary care physicians.

Relationship between leisure activity and depression in Chinese older adults: chain mediating effect of diet and cognition

Article

Full-text available

Jan 2025
BMC Geriatr

Background Leisure activity was associated with depression in older adults. However, the specific processes by which diet and cognition mediate the role of leisure activities and depression remain uncertain. The study aims to investigate the relationship between leisure activity and depression in older people and the underlying mechanisms involved, while constructing a comprehensive model that links these variables. Methods Data came from the 2018 Chinese Longitudinal Healthy Longevity Survey. Mini-Mental State Examination and CES-D-10 were used to assess cognition and depression, respectively. PROCESS macro was employed to assess the mediation effects of diet and cognition on the relationship between leisure activity and depression. Results Leisure activity was negatively associated with depression, with 35.90% of the total effect mediated through dietary diversity and cognitive function, of which 1.28% was from the chain-mediated effect of dietary diversity and cognition. In addition, 20.94% of the total effect mediated through a plant-based diet and cognitive function, of which 0.43% was from the chain-mediated effect of plant-based diet and cognition. Conclusions Leisure activities are linked to depression, with diet and cognition acting as chain-mediating factors. Public health experts recommend that older adults engage in leisure activities, ensure a broad spectrum of dietary intake, and prioritize the augmentation of plant-based diets as preventative strategies against depression.

Development and Validation of a Dynamic Nomogram for Predicting Cognitive Impairment Risk in Older Adults with Dentures: Analysis from CHARLS and CLHLS Data

Preprint

Full-text available

Nov 2024

Background and Aims Cognitive impairment is a common issue among the elderly, with denture use identified as a potential, easily recognizable clinical risk factor. However, the link between denture wear and cognitive decline in elderly Chinese adults remains understudied. This study aimed to develop and validate a dynamic nomogram to predict the risk of cognitive impairment in community-dwelling elderly denture wearers. Methods Participants were divided into development, internal, and external validation sets. The imbalanced data in the development set were first processed using the Synthetic Minority Over-sampling Technique (SMOTE), followed by predictor selection using the Least Absolute Shrinkage and Selection Operator (LASSO). A nomogram was then constructed to dynamically display and present the results. Receiver operating characteristic curve, sensitivity, specificity, accuracy, precision, F1 Score, calibration curve, and decision curve analysis were used to evaluate the validity of the model in terms of identification, calibration, and clinical validity. Results We identified five factors (age, residence, education, IADL, and depression) to construct the nomogram. The area under the curve of the prediction model was 0.854 (95%CI 0.839–0.870) in the development set, 0.841 (95%CI 0.805–0.877) in the internal validation set, and 0.856 (95%CI 0.838–0.873) in the external validation set. Calibration curves indicated significant agreement between predicted and actual values, and decision curve analysis demonstrated valuable clinical application. Conclusions Five factors were chosen as the final for the established nomogram in predicting the risk of cognitive impairment in older denture wearers. The nomogram has acceptable discrimination and can be used in the planning of preventive interventions for cognitive impairment among older denture-wearing populations by healthcare professionals and community health workers.

Protective Factors Influencing Cognitive Function Among Middle-Aged Adults in Pakistan

Article

Full-text available

Sep 2024

Background: The rapid increase in the aging population and the critical role of cognitive functioning in successful aging have shifted scholarly focus toward identifying its risk and protective factors. This study aimed to examine the protective correlates of cognitive functioning among middle-aged adults in Pakistan. Methodology: A correlational research design was employed, and purposive sampling was used to recruit participants. The sample size of 140 middle-aged adults (males = 43, females = 97), aged 35–55 years (M = 44.23, SD = 7.1), was calculated using G-power analysis. Data collection tools included the Montreal Cognitive Assessment (MoCA), the Islamic Practices subscale, and a demographic questionnaire. Statistical analyses were conducted using SPSS version 23. Results: Cognitive functioning was positively associated with education, number of friends, and participation in religious activities. In contrast, negative relationships were observed with age, number of children, obesity, hypertension, and comorbidities. Regression analysis indicated that education, social connections, and religious participation were significant positive predictors of cognitive functioning, while age and obesity emerged as significant negative predictors. Conclusion: The findings suggest that various modifiable protective factors can enhance cognitive functioning. These insights emphasize the importance of addressing modifiable factors to mitigate the effects of normal and pathological aging, offering valuable guidance for middle-aged adults and healthcare professionals.

A Multivariable Prediction Model for Mild Cognitive Impairment and Dementia: Algorithm Development and Validation

Article

Nov 2024

Background Mild cognitive impairment (MCI) poses significant challenges in early diagnosis and timely intervention. Underdiagnosis, coupled with the economic and social burden of dementia, necessitates more precise detection methods. Machine learning (ML) algorithms show promise in managing complex data for MCI and dementia prediction. Objective This study assessed the predictive accuracy of ML models in identifying the onset of MCI and dementia using the Korean Longitudinal Study of Aging (KLoSA) dataset. Methods This study used data from the KLoSA, a comprehensive biennial survey that tracks the demographic, health, and socioeconomic aspects of middle-aged and older Korean adults from 2018 to 2020. Among the 6171 initial households, 4975 eligible older adult participants aged 60 years or older were selected after excluding individuals based on age and missing data. The identification of MCI and dementia relied on self-reported diagnoses, with sociodemographic and health-related variables serving as key covariates. The dataset was categorized into training and test sets to predict MCI and dementia by using multiple models, including logistic regression, light gradient-boosting machine, XGBoost (extreme gradient boosting), CatBoost, random forest, gradient boosting, AdaBoost, support vector classifier, and k-nearest neighbors, and the training and test sets were used to evaluate predictive performance. The performance was assessed using the area under the receiver operating characteristic curve (AUC). Class imbalances were addressed via weights. Shapley additive explanation values were used to determine the contribution of each feature to the prediction rate. Results Among the 4975 participants, the best model for predicting MCI onset was random forest, with a median AUC of 0.6729 (IQR 0.3883-0.8152), followed by k-nearest neighbors with a median AUC of 0.5576 (IQR 0.4555-0.6761) and support vector classifier with a median AUC of 0.5067 (IQR 0.3755-0.6389). For dementia onset prediction, the best model was XGBoost, achieving a median AUC of 0.8185 (IQR 0.8085-0.8285), closely followed by light gradient-boosting machine with a median AUC of 0.8069 (IQR 0.7969-0.8169) and AdaBoost with a median AUC of 0.8007 (IQR 0.7907-0.8107). The Shapley values highlighted pain in everyday life, being widowed, living alone, exercising, and living with a partner as the strongest predictors of MCI. For dementia, the most predictive features were other contributing factors, education at the high school level, education at the middle school level, exercising, and monthly social engagement. Conclusions ML algorithms, especially XGBoost, exhibited the potential for predicting MCI onset using KLoSA data. However, no model has demonstrated robust accuracy in predicting MCI and dementia. Sociodemographic and health-related factors are crucial for initiating cognitive conditions, emphasizing the need for multifaceted predictive models for early identification and intervention. These findings underscore the potential and limitations of ML in predicting cognitive impairment in community-dwelling older adults.

Assessment of prevalence, risk factors, and neuropsychiatric symptoms of mild neurocognitive disorder among elderly in Suez Canal Area

Article

Full-text available

Oct 2024

Background Mild neurocognitive disorder is mild reduction in cognitive abilities than a previous level, requiring compensatory strategies that help maintain independence, and is associated with behavioral and psychiatric symptoms. This cross-sectional comparative study aimed to evaluate prevalence of mild neurocognitive disorder, its risk factors, and associated neuropsychiatric symptoms. It included a sample of 156 elderly people ≥ 60 years old in Suez Canal Area from geriatric homes and primary health care centers. Study tools included a semi-structured clinical interview to assess sociodemographic, clinical, and lifestyle risk factors, DSM-5 criteria for diagnosis of neurocognitive disorders, the Montreal Cognitive Assessment Scale, and the Neuropsychiatric Inventory Questionnaire. Results Prevalence of mild neurocognitive disorder was 37.2% in total sample with mean total score of 22.7 ± 6.1 by Montreal Cognitive Assessment Scale. The most common subtype was amnestic multiple domain subtype (72.4%). Its predicting factors included advanced age, lower education, physical work, non-adherence to treatment, less physical activity, bone and joint disorders, and family history of cognitive impairment. The neuropsychiatric symptoms with highest scores were sleep/nighttime behavior, depression, irritability, and eating/appetite, respectively. Among the two study groups, geriatric home residents had highly significant lower cognitive scores ( p < 0.001) and higher Neuropsychiatric Inventory Questionnaire scores. Conclusion Mild neurocognitive disorder is common among elderly people and is associated with neuropsychiatric symptoms that need screening and management. Modifiable risk factors should be identified to provide interventions.

Investigating Modifiable Risk Factors Across Dementia Subtypes: Insights from the UK Biobank

Article

Full-text available

Aug 2024

This study investigates the relationship between modifiable risk factors and dementia subtypes using data from 460,799 participants in the UK Biobank. Utilizing univariate Cox proportional hazards regression models, we examined the associations between 83 modifiable risk factors and the risks of all-cause dementia (ACD), Alzheimer’s disease (AD), and vascular dementia (VD). Composite scores for different domains were generated by aggregating risk factors associated with ACD, AD, and VD, respectively, and their joint associations were assessed in multivariable Cox models. Additionally, population attributable fractions (PAF) were utilized to estimate the potential impact of eliminating adverse characteristics of the risk domains. Our findings revealed that an unfavorable medical history significantly increased the risk of ACD, AD, and VD (hazard ratios (HR) = 1.88, 95% confidence interval (95% CI): 1.74–2.03, p < 0.001; HR = 1.80, 95% CI: 1.54–2.10, p < 0.001; HR = 2.39, 95% CI: 2.10–2.71, p < 0.001, respectively). Blood markers (PAF = 12.1%; 17.4%) emerged as the most important risk domain for preventing ACD and VD, while psychiatric factors (PAF = 18.3%) were the most important for preventing AD. This study underscores the potential for preventing dementia and its subtypes through targeted interventions for modifiable risk factors. The distinct insights provided by HR and PAF emphasize the importance of considering both the strength of the associations and the population-level impact of dementia prevention strategies. Our research provides valuable guidance for developing effective public health interventions aimed at reducing the burden of dementia, representing a significant advancement in the field.

Prävention des kognitiven Abbaus im Alter [Prevention of cognitive decline in old age : Selected primary preventive approaches]

Article

Aug 2024
Z GERONTOL GERIATR

Derzeit sind 1,8 Millionen Menschen in Deutschland von einer Demenz betroffen. Trotz Forschungsfortschritten und neuen Therapien gibt es für die meisten Demenzerkrankungen keine Heilung. Die Evidenzlage bezüglich der Prävention von kognitivem Abbau im Alter ist nicht eindeutig. Neben einer optimierten Einstellung von medikamentösen Behandlungen (z. B. arterieller Hypertonie und Diabetes mellitus) spielen selbstbeeinflussbare Präventionsmaßnahmen eine wichtige Rolle. Hierzu zählen Bereiche wie körperliche und kognitive Aktivität, Behebung von Schwerhörigkeit, Schlaf, soziale Kontakte, Alkohol- als auch Tabakkonsumverzicht und Ernährung. Multimodale Konzepte und digitale Ansätze erscheinen vielversprechend, und ein Evidenzzuwachs wird in den kommenden Jahren erwartet. There are currently 1.8 million people in Germany affected by dementia. Despite advances in research and new treatments, there is no cure for most cases of dementia. The evidence regarding the prevention of cognitive decline in old age is unclear. In addition to the optimized adjustment of drug treatment (e.g., arterial hypertension and diabetes mellitus), preventive measures that can be influenced by individuals themselves play an important role. These include areas such as physical and cognitive activity, remedying hearing loss, sleep, social contacts, abstaining from alcohol as well as tobacco consumption and nutrition. Multimodal concepts and digital approaches appear to be promising and an increase in evidence is expected in the coming years.

Cognitive impairment and associated factors among patients with diabetes mellitus in Africa: a systematic review and meta-analysis

Article

Full-text available

Jul 2024

Background Inappropriate management of blood sugar in patients with diabetes mellitus leads to micro-vascular and macro-vascular complications, subsequently leading to high morbidity and mortality rates. In addition, diabetes independently increases the occurrence of cognitive impairment complicated by dementia. Scientific evidence on the magnitude of cognitive impairment will provide a sound basis for the determination of healthcare needs and the planning of effective healthcare services. Despite this, there are no comprehensive data on the prevalence and associated factors of cognitive impairment among patients with diabetes in Africa. Methods To identify relevant articles for this review, we searched PubMed, Cochrane Library, Science Direct, African Journals Online, and Google Scholar. After extraction, the data were imported into Stata software version 11 (Stata Corp., TX, USA) for further analysis. The random-effects model, specifically the DerSimonian and Laird (D+L) pooled estimation method, was used due to the high heterogeneity between the included articles. Begg’s and Egger’s regression tests were used to determine the evidence of publication bias. Sub-group analyses and sensitivity analyses were also conducted to handle heterogeneity. Results The pooled prevalence of cognitive impairment among patients with diabetes in Africa is found to be 43.99% (95% CI: 30.15–57.83, p < 0.001). According to our analysis, primary level of education [pooled odds ratio (POR) = 6.08, 95% CI: 3.57–10.36, I ² = 40.7%], poorly controlled diabetes mellitus (POR = 5.85, 95% CI: 1.64–20.92, I ² = 87.8%), age above 60 years old (POR = 3.83, 95% 95% CI: 1.36–10.79, I ² = 63.7%), and diabetes duration greater than 10 years (POR = 1.13; 95% CI: 1.07–1.19, I ² = 0.0%) were factors associated with cognitive impairment among patients with diabetes. Conclusion Based on our systematic review, individuals with diabetes mellitus exhibit a substantial prevalence rate (43.99%) of cognitive impairment. Cognitive impairment was found to be associated with factors such as primary level of education, poorly controlled diabetes mellitus, age above 60 years, and diabetes duration greater than 10 years. Developing suitable risk assessment tools is crucial to address uncontrolled hyperglycemia effectively. Systematic review registration https://www.crd.york.ac.uk/prospero, identifier CRD42024561484.

Prevalence of Cognitive Impairment among Iraqi Patients with Ankylosing Spondylitis

Article

Full-text available

Jul 2024

Background Ankylosing spondylitis (AS) is the prototype of spondyloarthropathies and one of the common rheumatic diseases (RDs). Various degrees of cognitive impairment have been reported with most autoimmune RDs. Objectives To estimate the prevalence of cognitive impairment in AS patients and its relationship to disease activity and functional limitations and the effect of various sociodemographic and clinical characteristics on cognitive function in AS patients. Materials and Methods This case–control study comprised 100 patients with AS and 100 healthy subjects who were matched for age, gender, and educational level. Private interviews were conducted with participants to complete the questionnaire and evaluate cognitive function using the 6-item Cognitive Impairment Test (6-CIT) and the Montreal Cognitive Assessment (MoCA). Results According to MoCA, 48% of AS patients and 16% of healthy controls were cognitively impaired ( P = 0.001). By 6-CIT, 6% of the AS group had cognitive impairment, whereas all 100 controls had normal cognitive function ( P = 0.029). There was a significant direct correlation between 6-CIT score with marital status ( P = 0.020), BMI ( P = 0.021), and Bath Ankylosing Spondylitis Disease Activity Index ( P = 0.008) and inverse correlation with employment ( P = 0.015), education ( P = 0.008), and family income ( P = 0.12). There was significant direct correlation between MoCA with employment ( P = 0.009), education ( P = 0.005), family income ( P = 0.022), and use of non-steroidal anti-inflammatory drugs (NSAIDs) ( P = 0.008) and inverse correlation with marital status ( P = 0.002). Conclusions Patients with AS have a higher degree of cognitive impairment than healthy individuals. It is associated with disease activity, lower socioeconomic status, being widowed, and obesity. Use of NSAIDs is associated with lower cognitive impairment.

Investigating the relationships between motor skills, cognitive status, and area deprivation index in Arizona: a pilot study

Article

Full-text available

Jun 2024

Introduction Previous studies highlight the negative impact of adverse socioeconomic conditions throughout life on motor skills and cognitive health. Factors such as cognitive activity, physical activity, lifestyle, and socioeconomic position significantly affect general health status and brain health. This pilot study investigates the relationships among the Area Deprivation Index (ADI)—a measure of neighborhood-level socioeconomic deprivation, brain structure (cortical volume and thickness), and cognitive status in adults in Arizona. Identifying measures sensitive to ADI could elucidate mechanisms driving cognitive decline. Methods The study included 22 adults(mean age = 56.2 ± 15.2) in Arizona, residing in the area for over 10 years(mean = 42.7 ± 15.8). We assessed specific cognitive domains using the NeuroTrax™ cognitive screening test, which evaluates memory, executive function, visual–spatial processing, attention, information processing speed, and motor function. We also measured cortical thickness and volume in 10 cortical regions using FreeSurfer 7.2. Linear regression tests were conducted to examine the relationships between ADI metrics, cognitive status, and brain health measures. Results Results indicated a significant inverse relationship between ADI metrics and memory scores, explaining 25% of the variance. Both national and state ADI metrics negatively correlated with motor skills and global cognition (r’s < −0.40, p’s < 0.05). In contrast, ADI metrics generally positively correlated with motor-related volumetric and cortical thickness measures (r’s > 0.40, p’s < 0.05). Conclusion The findings suggest that neighborhood-level social deprivation might influence memory and motor status, primarily through its impact on motor brain health.

The Cognitive Benefits and Neurobiological Impacts of Learning a Second/Foreign Language: A Study on Enhancing Cognitive Function and Dementia

Article

Full-text available

Apr 2024

Cognitive SuperAging in Physically Active Women (COSACTIW): Study Protocol and data from the NANOK

Article

Mar 2024

Exploring the Relationship Between Living Arrangements and Cognitive Function in Older Adults of Kermanshah City (2022–2023)

Article

Full-text available

Apr 2024
Ageing Int

Objectives The cognitive function of older adults is an important indicator of healthy aging. Living arrangements have been identified as a potentially important factor affecting cognitive function among older adults. This study investigated the relationship between living arrangements and cognitive function among older adults aged 65 years and older in Kermanshah City, Iran. Methods The cross-sectional study design was used in this study. Participants aged 65 years and older in Kermanshah City, Iran were recruited for the study. The Neuropsychiatric Unit Cognitive Assessment (NUCOG) was used to assess cognitive function, and demographic information was collected to assess living arrangements. Results The study found that cognitive function was generally within the normal range among older adults, and that age, education level, and living arrangements were significantly associated with cognitive performance. Discussion These results highlight the importance of considering demographic factors when developing interventions aimed at promoting cognitive health among older adults.

Language Diversity Across Home and Work Contexts Differentially Impacts Age- and Menopause-Related Declines in Cognitive Control in Healthy Females

Article

Full-text available

Apr 2024

Menopause is associated with declines in cognitive control. However, there is individual variability in the slope of this decline. Recent work suggests that indices of cognitive control are mediated by communicative demands of the language environment. However, little is known about how the impact of bilingual experience generalizes across the lifespan, particularly in females who exhibit steeper cognitive decline due to increasing age and menopausal transition. Thus, we investigated whether diversity of language use in distinct communicative contexts modulated the effects of aging and menopause on cognitive control in an adult lifespan sample of healthy females. We performed robust linear regressions on a sample of 120 females (age range 20–65 years) to characterize age- (n = 120) and menopause-related (n = 59) declines in cognitive control (as assessed by the Wisconsin Card Sorting Test) and to determine whether they are modulated by different facets of bilingual language experience, including the diversity of language use (i.e., language entropy) in home and workplace environments. Workplace but not home language diversity modulated age- and menopause-related declines in cognitive control, suggesting that females may compensate for decline by virtue of adapting to the externally imposed demands of the language environment. These findings have implications for identifying which aspects of bilingual experience may contribute to cognitive reserve in healthy aging.

Systematic Review of Longitudinal Evidence and Methodologies for Research on Neighborhood Characteristics and Brain Health

Article

Full-text available

Mar 2024
Publ Health Rev

Objective: Synthesize longitudinal research evaluating neighborhood environments and cognition to identify methodological approaches, findings, and gaps. Methods: Included studies evaluated associations between neighborhood and cognition longitudinally among adults >45 years (or mean age of 65 years) living in developed nations. We extracted data on sample characteristics, exposures, outcomes, methods, overall findings, and assessment of disparities. Results: Forty studies met our inclusion criteria. Most (65%) measured exposure only once and a majority focused on green space and/or blue space (water), neighborhood socioeconomic status, and recreation/physical activity facilities. Similarly, over half studied incident impairment, cognitive function or decline (70%), with one examining MRI (2.5%) or Alzheimer’s disease (7.5%). While most studies used repeated measures analysis to evaluate changes in the brain health outcome (51%), many studies did not account for any type of correlation within neighborhoods (35%). Less than half evaluated effect modification by race/ethnicity, socioeconomic status, and/or sex/gender. Evidence was mixed and dependent on exposure or outcome assessed. Conclusion: Although longitudinal research evaluating neighborhood and cognitive decline has expanded, gaps remain in types of exposures, outcomes, analytic approaches, and sample diversity.

Disparities in Access to Diagnostic Evaluation for Alzheimer’s Disease in Individuals Dually Eligible for Medicare and Medicaid: A Modeling Study

Article

Full-text available

Mar 2024
J ALZHEIMERS DIS

Background Individuals dually eligible for Medicare and Medicaid (duals) may face greater obstacles to access to disease-modifying Alzheimer’s treatments in spite of their higher disease burden, because of clinicians’ reluctance to accept Medicaid and the so-called “lesser of” policy, under which Medicaid may pay providers lower rates. Objective To project differential wait times for duals compared to Medicare-only beneficiaries by state. Methods We used State Medicaid payment policy and Medicare enrollment data and a Markov model to predict differential wait times for duals and non-duals from 2023 to 2050. We estimated available diagnostic appointments by state for both groups based on reluctance of clinicians to accept Medicaid and the “lesser of” policy for each year. Results We estimate overall average wait times of almost two years (22.9 months) but almost three times as long for duals (59.8 months) than non-duals (20.7 months) because of higher disease burden. The effects of Medicaid payment policy would increase average wait times for duals to 89 months with 20 states having wait times of 99 months or more, which would effectively deprive duals of access. Conclusions The added average wait times in many states would effectively deprive duals from access to treatment and translate into avoidable disease progression and mortality. Policy interventions to reduce financial and nonfinancial obstacles are dearly needed to avoid deepening disparities. Examples are coverage arrangements that integrate Medicare and Medicaid coverage, covering the co-payment for physician services in full, and stricter network adequacy requirements for Medicaid Managed Care plans.

Effect of a combined program of running exercise and environmental enrichment on memory function and neurogenesis markers in amyloid-beta-induced Alzheimer-like model

Article

Full-text available

Jan 2023

Objective(s) It is urgent to develop non-pharmacological interventions or multifactor combination approaches to combat Alzheimer’s disease (AD). The effect of exercise (EX) combined with environmental enrichment (EE) on behavioral phenotypes and neurogenesis markers in an Alzheimer-like rat model was investigated. Materials and Methods The groups consisted of AD, sham-operated, AD+EX, AD+EE, and AD+EX+EE. AD was produced by injection of amyloid-beta (1-42, 6 µg) intrahippocampally, and a daily treadmill for 3 consecutive weeks was used for EX animals. EE was a large cage (50× 50× 50 cm) containing differently shaped objects. Spatial learning and memory were evaluated in the Morris water maze (MWM), and a shuttle box was used to evaluate inhibitory avoidance memory. RT-PCR was performed to assess the expression of early neurogenesis markers, DCX, and Sox2 within the hippocampus. Results Pretreatment with exercise and EE, both individually and in combination, could provide protection from memory impairments in AD rats. Combined treatment led to a significantly more pronounced improvement in memory deficits of AD rats than either paradigm alone. Combination therapy with exercise and EE could also reverse the passive avoidance memory impairment and hippocampal DCX expression of AD rats to the control levels. Conclusion These data suggest that exercise in combination with cognitive engagement can provide a non-pharmacological and multidomain policy that may prevent or delay AD symptoms.

Feasibility and Acceptability of a Group Music Creativity Intervention for Adults with Varying Cognitive Function

Article

Nov 2023

Neighborhood resources and risk of cognitive decline among a community-dwelling long-term care population in the U.S

Article

Full-text available

Oct 2023

Objective To examine the associations between neighborhood resources (i.e., number of restaurants, recreation centers, or social services for seniors and persons with disability per land area) and cognitive decline among a community-dwelling long-term care population and whether they differ by baseline cognition status. Study design Prospective longitudinal cohort study. Methods We used a longitudinal dataset that assessed over a two-year period older adults receiving state-funded home- and community-based services in Michigan Metropolitan areas (N = 9,802) and applied nonlinear mixed models with a random intercept with Poisson distribution. Results Cognitively intact older adults were less likely to experience cognitive decline when they resided in resource-rich neighborhoods, compared to those cognitively intact but living in neighborhoods that lacked resources. But their cognitively impaired or dementia-diagnosed counterparts did not similarly benefit from living in neighborhoods with rich resources. Conclusions Neighborhood resources may be an important aspect of intervention to mitigate cognitive decline before older adults become cognitively impaired.

Availability of Cognitive Resources in Early Life Predicts Transitions Between Cognitive States in Middle and Older Adults From Europe

Article

Full-text available

Oct 2023

Background and Objectives The existing literature highlights the importance of reading books in middle-to-older adulthood for cognitive functioning; very few studies, however, have examined the importance of childhood cognitive resources for cognitive outcomes later in life. Research Design and Methods Using data from 11 countries included in the Survey of Health, Ageing and Retirement in Europe (SHARE) dataset (N=32,783), multi-state survival models (MSM) were fit to examine the importance of access to reading material in childhood on transitions through cognitive status categories (no cognitive impairment and impaired cognitive functioning) and death. Additionally, using the transition probabilities estimated by the MSMs, we estimated remaining years of life without cognitive impairment and total longevity. All models were fit individually in each country, as well as within the pooled SHARE sample. Results Adjusting for age, sex, education, and childhood SES, the overall pooled estimate indicated that access to more books at age 10 was associated with a decreased risk of developing cognitive impairment (HRadj=0.79, CI: 0.76–0.82). Access to childhood books was not associated with risk of transitioning from normal cognitive functioning to death, or from cognitive impairment to death. Total longevity was similar between participants reporting high (+1SD) and low (-1SD) number of books in the childhood home, however individuals with more access to childhood books lived a greater proportion of this time without cognitive impairment. Discussion and Implications Findings suggest that access to cognitive resources in childhood is protective for cognitive aging processes in older adulthood.

Spatiotemporal gait parameter fluctuations in older adults affected by mild cognitive impairment: comparisons among three cognitive dual-task tests

Article

Full-text available

Sep 2023
BMC Geriatr

Backgrounds Gait disorder is associated with cognitive functional impairment, and this disturbance is more pronouncedly when performing additional cognitive tasks. Our study aimed to characterize gait disorders in mild cognitive impairment (MCI) under three dual tasks and determine the association between gait performance and cognitive function. Methods A total of 260 participants were enrolled in this cross-sectional study and divided into MCI and cognitively normal control. Spatiotemporal and kinematic gait parameters (31 items) in single task and three dual tasks (serial 100-7, naming animals and words recall) were measured using a wearable sensor. Baseline characteristics of the two groups were balanced using propensity score matching. Important gait features were filtered using random forest method and LASSO regression and further described using logistic analysis. Results After matching, 106 participants with MCI and 106 normal controls were recruited. Top 5 gait features in random forest and 4 ~ 6 important features in LASSO regression were selected. Robust variables associating with cognitive function were temporal gait parameters. Participants with MCI exhibited decreased swing time and terminal swing, increased mid stance and variability of stride length compared with normal control. Subjects walked slower when performing an extra dual cognitive task. In the three dual tasks, words recall test exhibited more pronounced impact on gait regularity, velocity, and dual task cost than the other two cognitive tests. Conclusion Gait assessment under dual task conditions, particularly in words recall test, using portable sensors could be useful as a complementary strategy for early detection of MCI.

Hypotension and cognitive impairment among the elderly: Evidence from the CLHLS

Article

Full-text available

Sep 2023
PLOS ONE

Background While high blood pressure has been linked to cognitive impairment, the relationship between low blood pressure, especially hypotension, and cognitive impairment has not been well studied. Therefore, this study aimed to assess the prevalence of hypotension and cognitive impairment in the seniors of China, and the association between hypotension and cognitive function impairment. Methods The data was derived from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Systolic blood pressures (SBP) and diastolic blood pressures (DBP) were measured by objective examination. The Chinese version of the Mini-Mental State Examination (CMMSE) was used to evaluate the cognitive impairment of the elderly. Generalized linear models were conducted to evaluate the association of hypotension with cognitive impairment. Results The prevalence of hypotension and cognitive impairment in the Chinese elderly were 0.76% and 22.06%, respectively. Participants with hypotension, lower SBP, and lower DBP, had odds ratios of 1.62, 1.38, and 1.48 for cognitive impairment, respectively. Besides, the CMMSE scores decreased by 2.08, 0.86, and 1.08 in the elderly with hypotension, lower SBP, and DBP, compared with those with non-hypotension, higher SBP, and DBP, respectively. Subgroup analyses showed that the association of cognitive impairment with hypotension was stronger in Chinese elderly who had decreased activity of daily living. Moreover, there was statistical evidence of a nonlinear dose-response relationship of SBP and DBP with cognitive impairment (Pnonlinear < 0.05). Conclusion Hypotension was a potential risk factor for cognitive impairment of the Chinese elderly, especially for those having decreased activity of daily living. Blood pressure management should be conducted to prevent them from cognitive impairment.

Predictors of Negative and Positive Affect among People with Dementia: A Cross-Sectional Study

Article

Sep 2023

Background and Objectives: This cross-sectional study examined the predictors of negative and positive affect among individuals with dementia. Materials and Methods: A sample of 102 Jordanian participants diagnosed with dementia was recruited from residential care facilities, and data were collected using different measures. Results: The results revealed that higher levels of negative affect were significantly associated with increased physical and verbal agitation among individuals with dementia. Conversely, lower levels of positive affect were associated with residing in a nursing home. Conclusions: These findings highlight the importance of recognizing the impact of both negative and positive affect on the well-being of individuals with dementia. Interventions targeting the reduction of negative affect and promoting positive affect could alleviate agitation and enhance emotional closeness in this population.

Executive function deficits and medial temporal lobe atrophy in late-life depression and Alzheimer’s disease: a comparative study

Article

Full-text available

Aug 2023

Objectives Alzheimer’s disease (AD) and late-life depression (LLD) frequently exhibit executive function deficits (EFD) and medial temporal lobe atrophy (MTA) as shared characteristics. The objective of this research was to examine the utility of the Trail Making Test (TMT) and the MTA scale in distinguishing between LLD and AD. Methods A study of 100 patients, 50 with AD and 50 with LLD, was conducted using a cross-sectional design. The individuals were subjected to clinical evaluations to assess their level of depression and overall cognitive abilities, which included the Geriatric Depression Scale (GDS), Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA). We evaluated executive function deficits (EFD) through the use of the TMT, which includes both TMT-A and TMT-B. MTA was measured using magnetic resonance imaging. To evaluate the ability of TMT and MTA scale to distinguish between the two groups, a receiver operating characteristic (ROC) curve was utilized. To investigate the connections between MTA and neuropsychological measures, a correlation analysis was performed. Results AD patients exhibited notably reduced MMSE, MoCA, and GDS scores, as well as an increased MTA total scores, time spent on TMT-A, and TMT-B compared to LLD patients (p < 0.05). TMT-A and TMT-B both exhibited excellent discriminatory power between AD and LLD, achieving area under curve (AUC) values of 92.2 and 94.2%, respectively. In AD patients, there was a negative correlation between MMSE and MoCA scores and MTA scores, while in LLD patients, there was a positive correlation between time spent on TMT-A and GDS scores and MTA scores. Conclusion AD patients experience more severe EFD and MTA than LLD patients. The differential diagnosis of AD and LLD can be aided by the useful tool known as TMT. It is important to acknowledge that TMT is capable of capturing only a fraction of the executive function, thus necessitating a cautious interpretation of research findings.

Deep Learning Based Time-to-Event Prediction of MCI Transition Leveraging Sensor-captured Daily Activities Data

Article

Aug 2023

The Association between the Emotional Closeness, Negative and Positive Affection, and Agitation among Older Adult with Dementia: A Cross-sectional Study

Article

Full-text available

Oct 2023
Ageing Int

Previous studies revealed conflicting findings of prior research on whether older adults living in the community or nursing homes have better health outcomes. Moreover, there is an imperative need for similar studies to assess the associations between emotional closeness, positive and negative affections, and agitation in older adults with dementia. This descriptive correlational study was conducted on a convenience sample of 102 older adults with dementia in Jordan. This study used multiple observational and self-report questionnaires to achieve the study objectives. The results indicated that PWD residing in community settings measured statistically significantly lower mean physical non-aggressive behaviors scores than those living in NHs. Also, physical, aggressive, and verbal non-aggressive behaviors were significantly associated with emotional closeness and negative affection, respectively, among PWD. Moreover, physical, non-aggressive behaviors were significantly associated with living in NHs and the cognitive function of PWD. Future research would consider exploring further potential factors related to agitated behavior and affection among older PWDs. Experimental studies that intend to increase social support and emotional closeness levels thus alleviating negative affection and agitation, are recommended in the future.

RELAÇÕES ENTRE ARGUMENTAÇÃO E FLEXIBILIDADE COGNITIVA NO ENVELHECIMENTO TÍPICO: um estudo exploratório

Thesis

Full-text available

Aug 2022

Stefânio Ramalho do Amaral

Senescence is a set of natural processes resulting from the human being's maturity process and differs from senility, a group of pathological transformations of the individual. This study aimed empirically to investigate and discursively analyze the potential of a systematic intervention program focused on argumentation adapted for older adults with typical cognitive decline (senescent), specifically in processes related to argumentative flexibility, understood as a theoretical construct empirically observable through argumentative movements, as anticipation and response to multiple, contrary and divergent perspectives. The specificity of this thesis is: a) in the adaptation and application for senescent of a systematic intervention program focused on argumentation, and b) in the discursive analysis of the potential of said adaptation, specifically in processes related to cognitive and argumentative flexibilities. Participants were 15 people aged between 60 and 75 years, with typical cognitive decline, autonomy, and low rates of depression and anxiety. As a method, the Critical Debate Model was adapted in four cycles, during ten sessions, focusing on four topics: fake news, insertion of the elderly in Brazilian society in the 21st century, public policies for the older adults, and finitude. The transcripts of the interventions were analyzed in two stages, through the argumentative triadic unit – argument (point of view and justification), counter-argument, and answer – and anchored in discursive modalizers, in search of discursive indicators of argumentative flexibility. In the microanalysis – thorough and detailed analyses, which serve as an example of the analyzes carried out in the corpus – two participants intentionally selected who participated in all ten sessions. In the macroanalysis, six participants who attended more than seven sessions were intentionally selected, in search of possible changes in the frequency of discursive indicators during the intervention. When comparing the five initial and five final sessions, analyses indicated a tendency towards an increase in the density of flexibilities movements and a decrease in conservative movements. These results suggest possible impacts of the intervention program on the participants' cognition, specifically regarding reflection, anticipation, and consideration of divergent perspectives.

Enhanced social interaction protects cognition by preserving synapse numbers

Article

Mar 2025
BRAIN RES

Cunyi Xu

A systematic review of epidemiological studies of life course socioeconomic status and adult structural brain changes

Article

Feb 2025
NEUROSCI BIOBEHAV R

Effectiveness of regional DTI measures in distinguishing Alzheimer’s disease, MCI and, normal aging

Article

Feb 2021

Particulate matter, socioeconomic status, and cognitive function among older adults in China

Article

Apr 2025
ARCH GERONTOL GERIAT

Qi Zhao

The Effect of Social Exclusion on the Cognitive Health of Middle-aged and Older Adults: a Systematic Review

Article

Dec 2024
ARCH GERONTOL GERIAT

Diminished Returns of Educational Attainment on Numeracy Score of Latino Populations: Insights from UAS Data

Article

Aug 2024

Background Educational attainment is a well-established social determinant of various domains of cognitive function across the lifespan. However, the theory of Minorities’ Diminished Returns (MDRs) suggests that the health benefits of educational attainment tend to be weaker for ethnic minorities compared to non-Latino Whites. This phenomenon may reflect the impact of structural inequalities, social stratification, and historical disadvantage. Objective This study examines whether the association between educational attainment and numeracy score, one domain of cognitive function, is weaker in Latino individuals compared to non-Latino individuals, as predicted by the MDRs framework. Methods Data were drawn from the 2014 wave of the Understanding America Study (UAS), a national internet-based panel. Numeracy score, a domain of the cognitive function was measured using an 8-item measure. Linear regression models were used to analyze the association between educational attainment and numeracy score, with an interaction term for ethnicity × educational attainment to explore differences between Latino and non-Latino participants. Models were adjusted for age, gender, marital status, immigration, and employment, and results were presented as beta coefficients, p-values, and 95% confidence intervals (CIs). Results Overall, 5,659 participants entered our analysis. Higher educational attainment was positively associated with higher numeracy score for both Latino and non-Latino participants (p < 0.001). However, the interaction between education and ethnicity was significant (p < 0.05), indicating that Latino individuals experienced smaller numeracy benefits from education compared to non-Latino individuals. These results support the MDRs framework, suggesting that structural barriers may reduce the numeracy returns of education for Latino individuals. Conclusion This study provides evidence of diminished returns of educational attainment in terms of numeracy scores among Latino individuals. While education is a key determinant of cognitive abilities such as numeracy, its benefits are not equitably distributed across ethnic groups. Structural inequalities particularly in educational opportunities likely contribute to this disparity. Addressing these underlying factors through targeted policy interventions is necessary to promote cognitive equity for Latino populations.

Tıp Fakültesi Öğrencilerinin Çevre Tutumlarının Belirlenmesi ve Çevre Davranışlarının Değerlendirilmesi

Article

Sep 2024

Çevre davranışlarının geliştirilmesi için toplumda çevre sağlığı konusunda farkındalık oluşturularak bilgilendirilme yapılması; çevre bilincini benimsemiş nesillerin yetişmesi ve daha bilinçli, daha sorumlu bireylerin artması için atılması gereken adımların başında gelmektedir. Çalışmada bir üniversitenin tıp fakültesi öğrencilerinin çevreye yönelik tutumlarının belirlenmesi ve çevresel davranışlarının değerlendirilmesi amaçlanmıştır. Araştırma kesitsel bir çalışma olup çalışma grubunu bir üniversitenin Tıp Fakültesinde öğrenim gören 874 (%55,21) öğrenci oluşturmuştur. Anket formda bazı sosyodemografik özellikler, Çevresel Davranış Ölçeği ve araştırmacılar tarafından hazırlanan çevreye yönelik bazı sorular yer aldı. Anketler öğrenciler tarafından çevrim içi olarak dolduruldu. Analizler için Mann-Whitney U, Kruskal Wallis ve Spearman korelasyon testleri kullanıldı. Katılımcıların %37,5'ini (n=328) preklinik sınıflar, %62,5'ini (n=546) ise klinik sınıflar oluşturdu. Çalışmada 21 yaş ve altında olanlar, kadın cinsiyet, preklinik sınıflar, kendini çevre dostu olarak tanımlayanlar, çevre bilinci ve çevre sağlığı konusunda herhangi bir toplantıya katılmış ya da eğitim almış olanlar, evsel atıklarını organik/cam/plastik gibi gruplara ayıranlar, çevreye zararlı olabilecek atıkları izole edenler, kısa mesafeli seyahatler için araba kullanmayanlar ve tek kullanımlık malzeme kullanımından kaçınanların Çevresel Davranış Ölçeği puanları daha yüksek idi. Ölçekten alınan puan ile çevresel tutumlara ilişkin maddeler arasında orta düzeyde pozitif korelasyon bulundu (r=0.616; p<0.001). Çalışmamızda tıp fakültesi öğrencileri gibi topluma örnek teşkil eden kesimden çevre davranışı ve tutumlarının daha olumlu olması beklenmektedir. Çevre davranışının daha olumlu hale getirilmesi için geri dönüşüm projelerinin desteklenmesi, öğrenim müfredatlarına çevre bilincine yönelik ders programlarının eklenmesi ve çevre sağlığı alanında yeni araştırmaların yapılması önerilebilir.

Association between cognitive impairment and socioeconomic and sociodemographic factors in Colombian older adults

Article

Aug 2024

Alzheimer's Diagnosis: Harnessing Machine Learning and Deep Learning for Enhanced Prediction and Understanding

Chapter

Jun 2024

Alzheimer's disease poses a serious threat to world health, affecting millions of people, due to its irreversible nature. Accurate diagnosis and early detection are essential. This book chapter analyses the OASIS longitudinal dataset and delivers thorough research using machine learning (ML) techniques. The goal of this research is to accurately forecast the development of dementia, offering a proactive strategy to address the rising incidence of Alzheimer's. Through the analysis of a variety of variables, such as clinical evaluations and socioeconomic status, we identify trends influencing the illness. The chapter covers preprocessing, eight machine learning methods, hybrid deep learning techniques and exploratory data analysis, emphasising the effectiveness of random forest and AdaBoost. Surprisingly, 98.5% accuracy is achieved in deep learning using artificial neural networks. This chapter provides a comprehensive knowledge, bridging the gap between early prediction and personalised intervention in Alzheimer's disease, culminating in a predictive dashboard.

Trajectories of Cognitive Decline in Different Domains Prior to AD onset in Persons with Mild Cognitive Impairment

Article

Feb 2024
ARCH GERONTOL GERIAT

Childhood Maltreatment and Dementia Risk Factors in Midlife: A Prospective Investigation

Article

Dec 2023
CURR ALZHEIMER RES

Background Previous studies have linked childhood adversities to dementia risk, yet most studies are cross-sectional in design and utilize retrospective self-reports to assess childhood experiences. These design characteristics make it difficult to establish temporal order and draw firm conclusions. Objective Using a longitudinal design, we sought to determine whether childhood maltreatment predicts dementia risk factors in middle adulthood. Methods Data have been obtained from a prospective cohort design study of children with documented cases of childhood maltreatment (ages 0-11 years at case identification) and demographically matched controls who were followed up and interviewed in middle adulthood. Outcomes were assessed through a medical examination and interview, and 807 of the cases that included blood collection at mean age 41. Dementia risk were investigated using 11 potentially modifiable risk factors. Results Compared to controls, individuals with histories of childhood maltreatment had a higher risk of low educational attainment, low social contact, smoking, and clinical depression, and a higher total number of dementia risk factors. In general, childhood maltreatment predicted a higher risk of dementia for females, males, and Black and White participants. Black maltreated participants had a greater risk for traumatic brain injury compared to Black controls. Physical abuse, sexual abuse, and neglect, each predicted a higher number of dementia risk factors in mid-life. Conclusion These findings provide evidence that childhood maltreatment increases the risk for dementia in mid-life and has a demonstrable impact lasting over 30 years. Reducing the prevalence of mid-life dementia risk factors could reduce the risk of later-life dementia.

Neural Correlates of Brain Reserve: A Neuroimaging Perspective

Chapter

Jun 2023

Brain (BR) and cognitive reserve (CR) are known to modulate the clinical features of Alzheimer’s disease (AD). This is a critical issue especially in the absence of disease modifying treatments, but with non-pharmacological interventions available which might delay patients’ cognitive disabilities. We reported here a selection of studies investigating the neurobiological substrate of BR and CR in patients with AD at different clinical stages.KeywordsBrain reserveCognitive reserveAlzheimer diseaseMild cognitive impairmentQuantitative magnetic resonance imaging

Moderating effects of cognitive reserve on the relationship between brain structure and cognitive abilities in middle-aged and older adults

Article

Apr 2023
NEUROBIOL AGING

The cognitive reserve (CR) hypothesis is reinforced by negative moderating effects, suggesting that those with higher CR are less reliant on brain structure for cognitive function. Previous research on CR's moderating effects yielded inconsistent results, motivating our 3 studies using UK Biobank data. Study I examined five CR proxies' moderating effects on global, lobar, and regional brain-cognition models; study II extended study I by using a larger sample size; and study III investigated age-related moderating effects on the hippocampal regions. In study I, most moderating effects were negative and none survived the multiple comparison correction, but study II identified 13 global-level models with significant negative moderating effects that survived correction. Study III showed age influenced CR proxies' moderating effects in hippocampal regions. Our findings suggest that the effects of CR proxies on brain integrity and cognition varied depending on the proxy used, brain integrity indicators, cognitive domain, and age group. This study offers significant insights regarding the importance of CR for brain integrity and cognitive outcomes.

Influence of Education and Occupation on the Incidence of Alzheimer's Disease

Article

Full-text available

May 1994

Several cross-sectional studies have found an association between Alzheimer's disease (AD) and limited educational experience. It has been difficult to establish whether educational experience is a risk factor for AD because educational attainment can influence performance on diagnostic tests. This study was designed to determine whether limited educational level and occupational attainment are risk factors for incident dementia. Cohort incidence study. General community. A total of 593 nondemented individuals aged 60 years or older who were listed in a registry of individuals at risk for dementia in North Manhattan, NY, were identified and followed up. We reexamined subjects 1 to 4 years later with the identical standardized neurological and neuropsychological measures. Incident dementia. We used Cox proportional hazards models, adjusting for age and gender, to estimate the relative risk (RR) of incident dementia associated with low educational and occupational attainment. Of the 593 subjects, 106 became demented; all but five of these met research criteria for AD. The risk of dementia was increased in subjects with either low education (RR, 2.02; 95% confidence interval [Cl], 1.33 to 3.06) or low lifetime occupational attainment (RR, 2.25; 95% Cl, 1.32 to 3.84). Risk was greatest for subjects with both low education and low life-time occupational attainment (RR, 2.87; 95% Cl, 1.32 to 3.84). The data suggest that increased educational and occupational attainment may reduce the risk of incident AD, either by decreasing ease of clinical detection of AD or by imparting a reserve that delays the onset of clinical manifestations.

Classification criteria for mild cognitive impairment: A population-based validation study

Article

Full-text available

Feb 2001

To evaluate the predictive validity and temporal stability of diagnostic criteria for mild cognitive impairment (MCI). MCI has been proposed as a nosologic entity referring to elderly persons with subclinical cognitive deficits due to incipient dementia. Classification criteria, which have been derived from small, selected clinical groups, are currently disputed, and have not yet been assessed within the general population. Subjects meeting current criteria for MCI and also age-associated cognitive decline (AACD-a similar concept that is assumed to be related to normal cognitive aging processes rather than incipient dementia) were identified within each of three waves of a longitudinal population study, which included a standardized neurologic examination. In the general population, the prevalence of MCI was estimated to be 3.2% and AACD 19.3%. MCI was a poor predictor of dementia within a 3-year period, with an 11.1% conversion rate. Subjects with MCI also constituted an unstable group, with almost all subjects changing category each year. Discriminant function analysis failed to isolate a homogeneous clinical group. Subjects classified as AACD, contrary to the theoretical assumptions underlying the disorder, represented a more stable group, with a 28.6% conversion rate to dementia over 3 years (relative risk = 21.2). MCI criteria perform poorly when applied to a representative population sample. The authors propose modifications to current diagnostic criteria to increase their capacity to detect incipient dementia.

Participation in Cognitively Stimulating Activities and Risk of Incident Alzheimer Disease

Article

Full-text available

Mar 2002

Frequent participation in cognitively stimulating activities has been hypothesized to reduce risk of Alzheimer disease (AD), but prospective data regarding an association are lacking. To test the hypothesis that frequent participation in cognitive activities is associated with a reduced risk of AD. Longitudinal cohort study with baseline evaluations performed between January 1994 and July 2001 and mean follow-up of 4.5 years. A total of 801 older Catholic nuns, priests, and brothers without dementia at enrollment, recruited from 40 groups across the United States. At baseline, they rated frequency of participation in common cognitive activities (eg, reading a newspaper), from which a previously validated composite measure of cognitive activity frequency was derived. Clinical diagnosis of AD by a board-certified neurologist using National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association criteria and change in global and specific measures of cognitive function, compared by cognitive activity score at baseline. Baseline scores on the composite measure of cognitive activity ranged from 1.57 to 4.71 (mean, 3.57; SD, 0.55), with higher scores indicating more frequent activity. During an average of 4.5 years of follow-up, 111 persons developed AD. In a proportional hazards model that controlled for age, sex, and education, a 1-point increase in cognitive activity score was associated with a 33% reduction in risk of AD (hazard ratio, 0.67; 95% confidence interval, 0.49-0.92). Results were comparable when persons with memory impairment at baseline were excluded and when terms for the apolipoprotein E epsilon4 allele and other medical conditions were added. In random-effects models that controlled for age, sex, education, and baseline level of cognitive function, a 1-point increase in cognitive activity was associated with reduced decline in global cognition (by 47%), working memory (by 60%), and perceptual speed (by 30%). These results suggest that frequent participation in cognitively stimulating activities is associated with reduced risk of AD.

What is cognitive reserve? Theory and research application of the reserve concept

Article

Full-text available

Apr 2002

Yaakov Stern

The idea of reserve against brain damage stems from the repeated observation that there does not appear to be a direct relationship between the degree of brain pathology or brain damage and the clinical manifestation of that damage. This paper attempts to develop a coherent theoretical account of reserve. One convenient subdivision of reserve models revolves around whether they envision reserve as a passive process, such as in brain reserve or threshold, or see the brain as actively attempting to cope with or compensate for pathology, as in cognitive reserve. Cognitive reserve may be based on more efficient utilization of brain networks or of enhanced ability to recruit alternate brain networks as needed. A distinction is suggested between reserve, the ability to optimize or maximize normal performance, and compensation, an attempt to maximize performance in the face of brain damage by using brain structures or networks not engaged when the brain is not damaged. Epidemiologic and imaging data that help to develop and support the concept of reserve are presented.

Late-life engagement in social and leisure activities is associated with a decreased risk of dementia: A longitudinal study from the Kungsholmen project

Article

Full-text available

Jul 2002
AM J EPIDEMIOL

Recent findings suggest that a rich social network may decrease the risk of developing dementia. The authors hypothesized that such a protective effect may be due to social interaction and intellectual stimulation. To test this hypothesis, data from the 1987-1996 Kungsholmen Project, a longitudinal population-based study carried out in a central area of Stockholm, Sweden, were used to examine whether engagement in different activities 6.4 years before dementia diagnosis was related to a decreased incidence of dementia. Dementia cases were diagnosed by specialists according to Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, criteria. After adjustment for age, sex, education, cognitive functioning, comorbidity, depressive symptoms, and physical functioning at the first examination, frequent (daily-weekly) engagement in mental, social, or productive activities was inversely related to dementia incidence. Adjusted relative risks for mental, social, and productive activities were 0.54 (95% confidence interval (CI): 0.34, 0.87), 0.58 (95% CI: 0.37, 0.91), and 0.58 (95% CI: 0.38, 0.91), respectively. Similar results were found when these three factors were analyzed together in the same model. Results suggest that stimulating activity, either mentally or socially oriented, may protect against dementia, indicating that both social interaction and intellectual stimulation may be relevant to preserving mental functioning in the elderly.

Prevalence and Natural Course of Aging-Associated Cognitive Decline in a Population-Based Sample of Young-Old Subjects

Article

Full-text available

Dec 2005

"Mild cognitive impairment" refers to cognitive deficits in older age that exceed age-related cognitive decline but do not fulfill criteria for dementia. Affected subjects are assumed to be at higher risk for the development of dementia, such as Alzheimer's disease. However, little is known about the group of young-old subjects with respect to the prevalence and natural course of cognitive decline. Within the population-based Interdisciplinary Longitudinal Study on Adult Development and Aging, neuropsychological functioning was assessed in 500 community-dwelling young-old subjects of two German urban regions who were born during 1930-1932. The participants were carefully screened for physical and mental health and reexamined 4 years later. The concept of "aging-associated cognitive decline" was applied. At baseline, 13.4% of the subjects fulfilled criteria for aging-associated cognitive decline. Four years later, the prevalence rates for rose to 23.6%; 52.3% of the subjects initially classified as having aging-associated cognitive decline retained the diagnosis at follow-up. Although subjects with aging-associated cognitive decline showed a reduced performance in all neuropsychological domains addressed, a significant decline was confined to delayed verbal memory test performance during the 4-year follow-up period in relation to comparison subjects. Aging-associated cognitive decline did not predict conversion to dementia during the follow-up interval. In young-old community-dwelling individuals, aging-associated cognitive decline is a frequent condition with a high temporal stability. During a 4-year follow-up, subjects with aging-associated cognitive decline deteriorated specifically in measures of episodic memory, underscoring the value of the respective deficits in characterizing "mild cognitive impairment."

Mental, Physical and Social Components in Leisure Activities Equally Contribute to Decrease Dementia Risk

Article

Full-text available

Feb 2006

There is accumulating evidence in the literature that leisure engagement has a beneficial effect on dementia. Most studies have grouped activities according to whether they were predominantly mental, physical or social. Since many activities contain more than one component, we aimed to verify the effect of all three major components on the dementia risk, as well as their combined effect. A mental, social and physical component score was estimated for each activity by the researchers and a sample of elderly persons. The correlation between the ratings of the authors and the means of the elderly subjects' ratings was 0.86. The study population consisted of 776 nondemented subjects, aged 75 years and above, living in Stockholm, Sweden, who were still nondemented after 3 years and were followed for 3 more years to detect incident dementia cases. Multi-adjusted relative risks (RRs) of dementia for subjects with higher mental, physical and social component score sums were 0.71 (95% CI: 0.49-1.03), 0.61 (95% CI: 0.42-0.87) and 0.68 (95% CI: 0.47-0.99), respectively. The most beneficial effect was present for subjects with high scores in all or in two of the components (RR of dementia = 0.53; 95% CI: 0.36-0.78). These findings suggest that a broad spectrum of activities containing more than one of the components seems to be more beneficial than to be engaged in only one type of activity.

Leisure Activities and the Risk of Dementia in the Elderly

Article

Full-text available

Jul 2003
NEW ENGL J MED

Participation in leisure activities has been associated with a lower risk of dementia. It is unclear whether increased participation in leisure activities lowers the risk of dementia or participation in leisure activities declines during the preclinical phase of dementia. We examined the relation between leisure activities and the risk of dementia in a prospective cohort of 469 subjects older than 75 years of age who resided in the community and did not have dementia at base line. We examined the frequency of participation in leisure activities at enrollment and derived cognitive-activity and physical-activity scales in which the units of measure were activity-days per week. Cox proportional-hazards analysis was used to evaluate the risk of dementia according to the base-line level of participation in leisure activities, with adjustment for age, sex, educational level, presence or absence of chronic medical illnesses, and base-line cognitive status. Over a median follow-up period of 5.1 years, dementia developed in 124 subjects (Alzheimer's disease in 61 subjects, vascular dementia in 30, mixed dementia in 25, and other types of dementia in 8). Among leisure activities, reading, playing board games, playing musical instruments, and dancing were associated with a reduced risk of dementia. A one-point increment in the cognitive-activity score was significantly associated with a reduced risk of dementia (hazard ratio, 0.93 [95 percent confidence interval, 0.90 to 0.97]), but a one-point increment in the physical-activity score was not (hazard ratio, 1.00). The association with the cognitive-activity score persisted after the exclusion of the subjects with possible preclinical dementia at base line. Results were similar for Alzheimer's disease and vascular dementia. In linear mixed models, increased participation in cognitive activities at base line was associated with reduced rates of decline in memory. Participation in leisure activities is associated with a reduced risk of dementia, even after adjustment for base-line cognitive status and after the exclusion of subjects with possible preclinical dementia. Controlled trials are needed to assess the protective effect of cognitive leisure activities on the risk of dementia.

Brain Reserve Hypothesis in Dementia

Article

Full-text available

Aug 2007
J ALZHEIMERS DIS

The concept of brain reserve refers to the ability to tolerate the age-related changes and the disease related pathology in the brain without developing clear clinical symptoms or signs. A considerable body of biological research has documented that a number of factors including education, work complexity, social network, and leisure activities may contribute to this reserve allowing cognitive function to be maintained in old ages. Epidemiological studies have also related these factors to the development of dementia, suggesting that intellectual challenges experienced across the whole life span may increase the brain reserve and be crucial for the occurrence of dementia symptoms in late life. This paper is a systematic review of the published epidemiological studies on this topic. The availability of numerous epidemiological and biological data investigating the reserve hypothesis in dementia permits some preliminary conclusions. High education, adult-life occupational work complexity, as well as a mentally and socially integrated lifestyle in late life could postpone the onset of clinical dementia and AD. The relevance of physical activity itself remains in debate, as most physical activities include also social and mental stimulation. Leisure activities with all three components – physical, mental and social – seem to have the most beneficial effect. Delaying dementia onset by five years would halve dementia prevalence and substantially decrease the number of dementia cases in the community.

“Mini-Mental State”. A practical method for grading the cognitive state of patients for the clinician

Book

Dec 1975
J PSYCHIATR RES

SKID Strukturiertes Klinisches Interview für DSM-IV. Achse I und II. Göttingen: Hogrefe

Article

Jan 1997

Mini-mental state-practical method for grading cognitive state of patients for clinicians

Article

Jan 1975
J PSYCHIATR RES

Design und Methodik der Interdisziplinären Längsschnittstudie des Erwachsenenalters

Article

Jan 2000

Die Interdisziplinäre Längsschnittstudie des Erwachsenenalters (ILSE) folgt in ihrer Anlage einem Design, wie es sich traditionell in entwicklungsrelevanten gerontologischen Studien findet (cf. Schaie 1996). Dementsprechend handelt es sich bei der ILSE um eine Querschnittsuntersuchung zweier Geburtskohorten zu einem ersten Messzeitpunkt, der mit nachfolgenden Messzeitpunkten zu einer sequenziellen Studie ausgebaut werden kann. Erst die Kombination eines längs- mit einem querschnittlichen Design wird es ermöglichen, sowohl intraindividuelle Entwicklungsverläufe als auch interindividuelle Unterschiede zu untersuchen, so dass differenzielle Angaben zur Stabilität und Veränderungen im mittleren und höheren Erwachsenenalter gemacht werden können (Maddox 1987; Thomae 1983). Eine Hauptaufgabe der Studie besteht darin, Auswertungen aus der ersten Untersuchungswelle gemäß des vorgegebenen Designs als Basisdaten für weitere, theoretisch motivierte Analysen zu Geschlechts-, Kohorten- und Ost-West-Unterschieden vorzulegen. In diesem Kapitel wird daher das Hauptdesign der Studie, verbunden mit damit zusammenhängenden methodischen Fragestellungen überblicksartig dargestellt.

Relation of Education and Occupation-based Socioeconomic Status to Incident Alzheimer's Disease

Article

Jan 2004
AM J EPIDEMIOL

Anita Karp

In this study, the authors evaluated whether the association between low educational level and increased risk of Alzheimer's disease (AD) and dementia may be explained by occupation-based socioeconomic status (SES). A cohort of 931 nondemented subjects aged ≥75 years from the Kungsholmen Project, Stockholm, Sweden, was followed for 3 years between 1987 and 1993. A total of 101 incident cases of dementia, 76 involving AD, were detected. Less-educated subjects had an adjusted relative risk of developing AD of 3.4 (95% confidence interval: 2.0, 6.0), and subjects with lower SES had an adjusted relative risk of 1.6 (95% confidence interval: 1.0, 2.5). When both education and SES were introduced into the same model, only education remained significantly associated with AD. Combinations of low education with low or high SES were associated with similar increased risks of AD, but well-educated subjects with low SES were not at high risk. Low SES at 20 years of age, even when SES was high at age 40 or 60 years, was associated with increased risk; however, this increase disappeared when education was entered into the model. In conclusion, the association between low education and increased AD risk was not mediated by adult SES or socioeconomic mobility. This suggests that early life factors may be relevant.

Vascular dementia: Diagnostic criteria for research studies: Report of the NINDS-AIREN International Workshop

Article

Feb 1993

Criteria for the diagnosis of vascular dementia (VaD) that are reliable, valid, and readily applicable in a variety of settings are urgently needed for both clinical and research purposes. To address this need, the Neuroepidemiology Branch of the National Institute of Neurological Disorders and Stroke (NINDS) convened an International Workshop with support from the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (AIREN), resulting in research criteria for the diagnosis of VaD. Compared with other current criteria, these guidelines emphasize (1) the heterogeneity of vascular dementia syndromes and pathologic subtypes including ischemic and hemorrhagic strokes, cerebral hypoxic-ischemic events, and senile leukoencephalopathic lesions; (2) the variability in clinical course, which may be static, remitting, or progressive; (3) specific clinical findings early in the course (eg, gait disorder, incontinence, or mood and personality changes) that support a vascular rather than a degenerative cause; (4) the need to establish a temporal relationship between stroke and dementia onset for a secure diagnosis; (5) the importance of brain imaging to support clinical findings; (6) the value of neuropsychological testing to document impairments in multiple cognitive domains; and (7) a protocol for neuropathologic evaluations and correlative studies of clinical, radiologic, and neuropsychological features. These criteria are intended as a guide for case definition in neuroepidemiologic studies, stratified by levels of certainty (definite, probable, and possible). They await testing and validation and will be revised as more information becomes available.

Late-Life Engagement in Social and Leisure Activities Is Associated with a Decreased Risk of Dementia: A Longitudinal Study from the Kungsholmen Project

Article

Jun 2002
AM J EPIDEMIOL

Hui-Xin Wang

Trail Making Test: Manual for Administration and Scoring

Article

Jan 1992

Ralph M. Reitan

Vascular dementia

Article

Aug 2001
ANN NEUROL

Gustavo Roman

Clinical diagnosis of Alzheimer's disease: Report of the NINCDS--ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease

Article

Jul 2011
NEUROLOGY

Clinical criteria for the diagnosis of Alzheimer's disease include insidious onset and progressive impairment of memory and other cognitive functions. There are no motor, sensory, or coordination deficits early in the disease. The diagnosis cannot be determined by laboratory tests. These tests are important primarily in identifying other possible causes of dementia that must be excluded before the diagnosis of Alzheimer's disease may be made with confidence. Neuropsychological tests provide confirmatory evidence of the diagnosis of dementia and help to assess the course and response to therapy. The criteria proposed are intended to serve as a guide for the diagnosis of probable, possible, and definite Alzheimer's disease; these criteria will be revised as more definitive information become available.

Mendes de Leon CFEvansDA Cognitive activity and the cognitive morbidity of Alzheimer disease

Article

Sep 2010
NEUROLOGY

To test the hypothesis that frequent cognitive activity predicts slower cognitive decline before dementia onset in Alzheimer disease (AD) and faster decline thereafter. As part of a longitudinal cohort study, older residents of a geographically defined population were assessed at 3-year intervals with brief cognitive performance tests from which a composite measure of global cognition was derived. After each wave of testing, a subset was sampled for clinical evaluation. The present analyses are based on 1,157 participants. They were free of dementia at study enrollment at which time they rated frequency of participation in common cognitively stimulating activities from which a previously validated summary measure was derived. They were sampled for clinical evaluation a mean of 5.6 years after enrollment and subsequently followed a mean of 5.7 years with brief cognitive performance testing at 3-year intervals. On clinical evaluation, 614 people had no cognitive impairment, 395 had mild cognitive impairment, and 148 had AD. During follow-up, the annual rate of global cognitive decline in persons without cognitive impairment was reduced by 52% (estimate = 0.029, SE = 0.010, p = 0.003) for each additional point on the cognitive activity scale. In the mild cognitive impairment group, cognitive decline rate was unrelated to cognitive activity (estimate = -0.019, SE = 0.018, p = 0.300). In AD, the mean rate of decline per year increased by 42% (estimate = 0.075, SE = 0.021, p < 0.001) for each point on the cognitive activity scale. Mentally stimulating activity in old age appears to compress the cognitive morbidity associated with AD by slowing cognitive decline before dementia onset and hastening it thereafter.

Clinical, pathological, and neurochemical changes in dementia: A subgroup with preserved mental status and numerous neocortical plaques

Article

Feb 1988

Postmortem examination was performed on 137 residents (average age 85.5 years) of a skilled nursing facility whose mental status, memory, and functional status had been evaluated during life. Seventy-eight percent were demented using conservative criteria; 55% had characteristic Alzheimer's disease. Choline acetyltransferase and somatostatin were significantly reduced in the brains of patients with Alzheimer's disease as compared with age-matched nursing home control subjects, although the degree of the reduction was less severe than found in subjects less than 80 years of age. Ten subjects whose functional and cognitive performance was in the upper quintile of the nursing home residents, as good as or better than the performance of the upper quintile of residents without brain pathology (control subjects), showed the pathological features of mild Alzheimer's disease, with many neocortical plaques. Plaque counts were 80% of those of demented patients with Alzheimer's disease. Choline acetyltransferase and somatostatin levels were intermediate between controls and demented patients with Alzheimer's disease. The unexpected findings in these subjects were higher brain weights and greater number of neurons (greater than 90 micron 2 in a cross-sectional area in cerebral cortex) as compared to age-matched nursing home control subjects. These people may have had incipient Alzheimer's disease but escaped loss of large neurons, or alternatively, started with larger brains and more large neurons and thus might be said to have had a greater reserve.

Factors Influencing the Self-Rating Depression Scale

Article

Jun 1967
ARCH GEN PSYCHIAT

William W. K. Zung

SINCE the initial publications on the development and validation of the Self-Rating Depression Scale (SDS),1,2 there has been continued interest in it. Diversity in the application of this tool is evidenced by its use in the programs of suicide prevention centers, alcoholism clinics, child guidance and adult psychiatric clinics, health and welfare agencies, and by various research groups, including the Veterans Administration Cooperative Studies in Psychiatry and the Early Clinical Drug Evaluation Unit of the Psychopharmacology Research Branch, National Institute of Mental Health. In a series of studies exploring social structure and mental illness, Redlich et al3-6 reported highly significant relationships between social class position and aspects of psychiatric disorders, such as prevalence of psychiatric patients, types of psychiatric disorders, and choice of treatment modalities. If these relationships exist as such, is there a significant correlation between social status and results

Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-ADRDA Work Group* under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease

Article

Aug 1984

Education and Other Measures of Socioeconomic Status and Risk of Incident Alzheimer Disease in a Defined Population of Older Persons

Article

Dec 1997
ARCH NEUROL-CHICAGO

To assess the relations of 3 measures of socioeconomic status (education, occupational prestige, and income) to risk of incident clinically diagnosed Alzheimer disease (AD). Cohort study with an average observation of 4.3 years. East Boston, Mass. a geographically defined community. A stratified random sample of 642 community residents 65 years of age and older who were free of AD at baseline. Clinical diagnosis of probable AD according to standard criteria, using structured uniform evaluation. The relations of the 3 measures of socioeconomic status to risk of disease were assessed using logistic regression analyses. In individual analyses, fewer years of formal schooling, lower income, and lower occupational status each predicted risk of incident AD; risk of disease decreased by approximately 17% for each year of education. In an analysis including all 3 measures, the effect of education on risk for disease remained approximately the same, but the effects of the other 2 measures were somewhat less and did not attain formal statistical significance, compared with separate analysis of each measure. Markers of lower socioeconomic status predict risk of developing incident AD. The mechanism of this relation is uncertain, but the possibility that it reflects unidentified and potentially reversible risk factors for the disease deserves careful investigation.

Prevalence of mild cognitive impairment in an elderly community sample (In Process Citation)

Article

Feb 1998
J NEURAL TRANSM-SUPP

The term "mild cognitive impairment" refers to cognitive deficits which exceed normal physiological aging processes, but do not fulfill the criteria for dementia. While recent studies indicate that the respective deficits can be reliably assessed, different diagnostic criteria have prevented a wide application of this diagnosis in clinical practice. The aims of the present study were (1) to assess the prevalence rates of four current diagnostic concepts and (2) to investigate mild cognitive impairment with respect to psychological and sociodemographic variables. Data from 202 probands recruited from the interdisciplinary longitudinal study on adult development were analyzed. On the time of examination, probands were between 60 to 64 years old and in a good health. The following prevalence rates were determined: 13.5% for age-associated memory impairment (AAMI), 6.5% for age-consistent memory impairment (ACMI), 1.5% for late-life forgetfulness (LLF), and 23.5% for aging-associated cognitive decline (AACD). Complaints of cognitive deficits were significantly correlated with higher scores on depression and neuroticism scales but with none of the neuropsychological measures. Reduced performance in neuropsychological tests was associated with a lower educational level and socioeconomic status. We conclude that the prevalence rates of mild cognitive impairment are highly dependent on the diagnostic criteria applied. In this respect the self-report of cognitive decline might be a less useful criteria. Longitudinal studies are warranted to further elucidate the predictive value of these diagnostic criteria.

Ten-year incidence of dementia in a rural elderly US community population: The MoVIES Project

Article

Mar 2000

To determine incidence rates by age, sex, and education of overall dementia and probable/ possible AD in a largely rural community. Ten-year prospective study of a randomly selected community sample aged 65+; biennial cognitive screening followed by standardized clinical evaluation. Incidence rates were estimated for overall dementia (Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., revised, criteria and Clinical Dementia Rating [CDR]) and for probable/possible AD (National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria). The cohort consisted of 1,298 individuals free of dementia at study entry. Among these, 199 incident (new) cases of overall (all-cause) dementia with CDR stage > or = 0.5, including 110 with CDR > or = 1, were detected during follow-up. Among the incident cases, 153 (76.9%) had probable/ possible AD. Age-specific incidence rates are reported for all dementia and for probable/possible AD, by sex and CDR stage. Among all-cause dementias with CDR = 0.5, controlling for age and education, men had a higher incidence rate than women. In the same group, those with less than high school education had significantly higher incidence rates than those with more education. Rates did not vary significantly by sex or education for probable/possible AD or for dementia with CDR > or = 1. Incidence rates of all dementias and of AD increased with age; men and those with lesser education had higher rates of possible/incipient dementia (CDR = 0.5) in this community. Potential explanations for these sex and education effects are discussed.

The Influence of Education on Clinically Diagnosed Dementia Incidence and Mortality Data From the Kungsholmen Project

Article

Dec 2001
ARCH NEUROL-CHICAGO

The relationship between education and Alzheimer disease (AD) or dementia has been widely examined and the evidence obtained is mixed. Several hypotheses have been proposed to explain the observed association between them. To further understand the relationship between education and incidence of clinically diagnosed AD or dementia. A community-based, dementia-free cohort of 1296 aged 75 years and older was followed up to detect incident AD or dementia cases using Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria. The vital status of all subjects who underwent the clinical examination at follow-up (n = 983) was ascertained for 5 years further. Data were analyzed with Cox proportional hazards model after adjustment for main potential confounders. Over an average (SD) of 2.8 (1.0) years of follow-up, 147 subjects were diagnosed as having dementia (109 subjects as having AD). Among those who were clinically examined at follow-up, 88 died with dementia (68 died with AD) within 5 years. Subjects with a low level of education (<8 vs > or =8 years) had a relative risk of 2.6 (95% confidence interval, 1.5-4.4) for AD and 1.7 (95% confidence interval, 1.1-2.6) for dementia. A low educational level was significantly related to all-cause mortality (relative risk, 1.3; 95% confidence interval, 1.0-1.7; P<.05), but not to the mortality of subjects with AD (relative risk, 1.1; 95% confidence interval, 0.5-2.2) or dementia (relative risk, 0.9; 95% confidence interval, 0.5-1.5). A low level of education is related to an increased incidence of clinical AD or dementia, but not to the mortality of subjects with AD or dementia. These findings can be accounted for by the "cognitive reserve" hypothesis. Alternatively, the observed association between educational level and incidence of AD or dementia may partly reflect detection bias, by which subjects with a low level of education tend to be clinically diagnosed at an earlier point in time.

Scarmeas N, Levy G, Tang MX, Manly J, Stern Y. Influence of leisure activity on the incidence of Alzheimer’s disease. Neurology. 57: 2236-2242

Article

Jan 2002

To determine whether leisure activities modify the risk for incident dementia. Although high educational and occupational attainments have been associated with reduced risk of incident dementia, the relation between leisure activities and dementia risk has not been adequately investigated. A total of 1,772 nondemented individuals aged 65 years or older, living in northern Manhattan, New York, were identified and followed longitudinally in a community-based cohort incidence study. Subjects' leisure activities at baseline were assessed, annual examinations with the same standardized neurologic and neuropsychological measures were performed for up to 7 years (mean 2.9 years), and incident dementia was assessed as the main outcome measure. Cox proportional hazards models, adjusting for age, ethnic group, education, and occupation, were used to estimate the relative risk (RR) of incident dementia associated with high leisure activities. Of the 1,772 subjects, 207 became demented. The risk of dementia was decreased in subjects with high leisure activities (RR, 0.62; 95% CI 0.46 to 0.83). The association of high leisure with decreased RR of incident dementia was present even when baseline cognitive performance, health limitations interfering with desired leisure activities, cerebrovascular disease, and depression were considered. The data suggest that engagement in leisure activities may reduce the risk of incident dementia, possibly by providing a reserve that delays the onset of clinical manifestations of the disease.

Risk Factors for Alzheimer's Disease: A Prospective Analysis from the Canadian Study of Health and Aging

Article

Oct 2002
AM J EPIDEMIOL

A prospective analysis of risk factors for Alzheimer's disease was a major objective of the Canadian Study of Health and Aging, a nationwide, population-based study. Of 6,434 eligible subjects aged 65 years or older in 1991, 4,615 were alive in 1996 and participated in the follow-up study. All participants were cognitively normal in 1991 when they completed a risk factor questionnaire. Their cognitive status was reassessed 5 years later by using a similar two-phase procedure, including a screening interview, followed by a clinical examination when indicated. The analysis included 194 Alzheimer's disease cases and 3,894 cognitively normal controls. Increasing age, fewer years of education, and the apolipoprotein E epsilon4 allele were significantly associated with increased risk of Alzheimer's disease. Use of nonsteroidal anti-inflammatory drugs, wine consumption, coffee consumption, and regular physical activity were associated with a reduced risk of Alzheimer's disease. No statistically significant association was found for family history of dementia, sex, history of depression, estrogen replacement therapy, head trauma, antiperspirant or antacid use, smoking, high blood pressure, heart disease, or stroke. The protective associations warrant further study. In particular, regular physical activity could be an important component of a preventive strategy against Alzheimer's disease and many other conditions.

Midlife income, occupation, APOE status, and dementia: A population-based study

Article

Oct 2002

To examine the relationship between socioeconomic factors and APOE carrier status on the development of dementia. Subjects were derived from random, population-based samples previously studied in surveys carried out in 1972, 1977, 1982, and 1987. After an average follow-up of 21 years, 1449 (73%) subjects aged 65 to 79 years were re-examined in 1998. The diagnosis of dementia among the nonparticipants was derived from patient records of the local hospitals and primary health care clinics. Low income level at old age was related to dementia, but low income level at midlife was not a risk factor for dementia. Dementia was also associated with decreasing income level, from midlife to old age 21 years later, when dementia was diagnosed. A sedentary occupation (office, service, or intellectual work) was associated with a decreased risk for dementia among participants; however, when the nonparticipants were included in the analysis, the associations were no longer significant. Low educational level and the APOE epsilon4 allele independently increased the risk for dementia. Reduction in income level during follow-up and low income level at old age might be the consequence of a dementing process rather than being associated with risk evolution of dementia.

Cognitive activity and incident AD in a population-based sample of older persons

Article

Jan 2003

Participation in cognitively stimulating activities is hypothesized to be associated with risk of AD, but knowledge about this association is limited. A biracial community in Chicago was censused, persons aged 65 years and older were asked to participate in an interview, and 6,158 of 7,826 (79%) eligible persons did so. As part of the interview, persons rated current frequency of participation in seven cognitive activities (e.g., reading a newspaper) and nine physical activities (e.g., walking for exercise) from which composite measures of cognitive and physical activity frequency were derived. Four years later, 1,249 of those judged free of AD were sampled for a detailed clinical evaluation of incident disease and 842 (74% of those eligible) participated. The composite measure of cognitive activity ranged from 1.28 to 4.71 (mean 3.30; SD 0.59), with higher scores indicating more frequent activity. A total of 139 persons met National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for AD on clinical evaluation. In a logistic regression model adjusted for age, education, sex, race, and possession of the APOE epsilon4 allele, a one-point increase in cognitive activity score was associated with a 64% reduction in risk of incident AD (OR 0.36; 95% CI 0.20 to 0.65). By contrast, weekly hours of physical activity (mean 3.5; SD 5.1) was not related to disease risk (OR 1.04; 95% CI 0.98 to 1.10). Education was associated with risk of AD and a similar trend was present for occupation, but these effects were substantially reduced when cognitive activity was added to the model. Frequency of participation in cognitively stimulating activities appears to be associated with risk of AD and may partially explain the association of educational and occupational attainment with disease risk.

The Effect of Education on Cognitive Performances and Its Implication for the Constitution of the Cognitive Reserve

Article

Feb 2003

Some studies have suggested that people with a high educational level have a lower risk of developing dementia compared to people with a low educational level. This protective effect of education has been explained by the constitution of a cognitive reserve which might delay the cognitive and functional expression of neurodegenerative illnesses. The aim of this study is, on the one hand, to evaluate the impact of education on cognitive functioning, which is thought to support the cognitive reserve capacity, and on the other, to determine the extent to which cognitive functioning is affected by other explanatory variables. The analysis was conducted on 1022 individuals without physical or neurological disorders in the Personnes Ages Quid study. These participants were aged 66 and over and had completed a neuropsychological battery. The effect of some demographic and socioeconomic variables on cognitive performance was also analyzed. Multivariate analysis showed a significant effect of education on most neuropsychological performances, independently of the other variables, and more particularly, in the high-attention-demanding tests. A principal component analysis demonstrated that education specifically increases 2 cognitive components: controlled processes and conceptualization ability. More-over, mental stimulation occurring after the education years, such as high-complex-activity occupations, seems to increase the controlled component. All these results suggest that the effect of education on cognitive reserve may be explained by an in-crease in controlled processes and conceptualization abilities. These 2 cognitive components might delay the clinical expression of neurodegenerative illnesses by maintaining global cognitive efficiency. Of these 2 components, controlled processes were also influenced by high attention-demanding occupations.

Zung Self Rating Depression Scale

Article

Feb 1965
ARCH GEN PSYCHIAT

William W. K. Zung

The fact that there is a need for assessing depression, whether as an affect, a symptom, or a disorder is obvious by the numerous scales and inventories available and in use today.

Relation of education and occupation-based socioeconomic status to incident Alzheimer's disease

Article

Feb 2004
AM J EPIDEMIOL

In this study, the authors evaluated whether the association between low educational level and increased risk of Alzheimer's disease (AD) and dementia may be explained by occupation-based socioeconomic status (SES). A cohort of 931 nondemented subjects aged > or = 75 years from the Kungsholmen Project, Stockholm, Sweden, was followed for 3 years between 1987 and 1993. A total of 101 incident cases of dementia, 76 involving AD, were detected. Less-educated subjects had an adjusted relative risk of developing AD of 3.4 (95% confidence interval: 2.0, 6.0), and subjects with lower SES had an adjusted relative risk of 1.6 (95% confidence interval: 1.0, 2.5). When both education and SES were introduced into the same model, only education remained significantly associated with AD. Combinations of low education with low or high SES were associated with similar increased risks of AD, but well-educated subjects with low SES were not at high risk. Low SES at 20 years of age, even when SES was high at age 40 or 60 years, was associated with increased risk; however, this increase disappeared when education was entered into the model. In conclusion, the association between low education and increased AD risk was not mediated by adult SES or socioeconomic mobility. This suggests that early life factors may be relevant.

Early Life Socioeconomic Status and Late Life Risk of Alzheimer’s Disease

Article

Feb 2005

The authors examined the relation of early life socioeconomic status to incident Alzheimer's disease (AD), level of cognition and rate of cognitive decline in old age. For up to 10 years, 859 older Catholic clergy members without dementia at baseline completed annual clinical evaluations as part of the Religious Orders Study. The evaluations included clinical classification of AD and detailed cognitive testing. At baseline, indicators of early life household socioeconomic level (e.g., parental education) and the county of birth were ascertained. Socioeconomic features of the birth county (e.g., literacy rate) were estimated with data from the 1920 US Census. Composite measures of early life household and community socioeconomic level were developed. In analyses that controlled for age, sex and education, higher household and community socioeconomic levels in early life were associated with higher level of cognition in late life but not with risk of AD or rate of cognitive decline. The results suggest that early life socioeconomic level is related to level of cognition in late life but not to rate of cognitive decline or risk of AD.

P3-154 The relationships between television viewing in midlife and the development of Alzheimer disease in a case-control study

Article

Aug 2005

The relationship between leisure activities and development of cognitive impairment in aging has been the subject of recent research. We examined television viewing in association with risk of developing Alzheimer's disease (AD) in a case-control study. Given recent focus on the importance of intellectually stimulating activities as preventive measures against cognitive decline, it is important to examine the effects of less stimulating but common activities. Data are from 135 Alzheimer's disease cases and 331 healthy controls. Demographic characteristics and life history questionnaire responses on the number of hours spent on 26 leisure activities during middle-adulthood (ages 40-59) were analyzed. Logistic regression was used to examine the effects of middle-adulthood leisure activities on case vs. control status. Results indicate that for each additional daily hour of middle-adulthood television viewing the associated risk of AD development, controlling for year of birth, gender, income, and education, increased 1.3 times. Participation in intellectually stimulating activities and social activities reduced the associated risk of developing AD. Findings are consistent with the view that participation in non-intellectually stimulating activities is associated with increased risk of developing AD, and suggest television viewing may be a marker of reduced participation in intellectually stimulating activities.

Cognitive Reserve and Alzheimer Disease

Article

Apr 2006
ALZ DIS ASSOC DIS

Yaakov Stern

Epidemiologic evidence suggests that individuals with higher IQ, education, occupational attainment, or participation in leisure activities have a reduced risk of developing Alzheimer disease (AD). The concept of cognitive reserve (CR) posits that individual differences in how tasks are processed provide differential reserve against brain pathology or age-related changes. This may take 2 forms. In neural reserve, preexisting brain networks that are more efficient or have greater capacity may be less susceptible to disruption. In neural compensation, alternate networks may compensate for pathology's disruption of preexisting networks. Imaging studies have begun to identify the neural substrate of CR. Because CR may modulate the clinical expression of AD pathology, it is an important consideration in studies of "preclinical" AD and treatment studies. There is also the possibility that directly enhancing CR may help forestall the diagnosis of AD.

Education and dementia - What lies behind the association?

Article

Nov 2007
NEUROLOGY

Low education seems to be associated with an increased risk of dementia and Alzheimer disease (AD). People with low education have unhealthier lifestyles and more cardiovascular risk factors, but it is unclear how this affects the association between education and dementia. Participants of the Cardiovascular Risk Factors, Aging and Dementia (CAIDE) study were derived from random, population-based samples previously studied in a survey in 1972, 1977, 1982, or 1987. After an average follow-up of 21 years, 1,449 individuals (72%) aged 65 to 79 participated in a re-examination in 1998. Compared to individuals with formal education of 5 years or less, those with 6 to 8 years of education had OR of 0.57 (95% CI 0.29 to 1.13), and those with 9 years of education or more had OR of 0.16 (95% CI 0.06 to 0.41) for dementia. The corresponding ORs for AD were 0.49 (0.24 to 1.00) and 0.15 (0.05 to 0.40). The associations remained unchanged after adjustments for several demographic, socioeconomic, vascular, and lifestyle characteristics. The results were similar among both men and women. ApoE4 did not modify the association, but the risk of dementia and AD was very low among ApoE4 noncarriers with high education. The association between low education and dementia is probably not explained by the unhealthy lifestyles of the less educated compared with higher educated persons. Higher educated persons may have a greater cognitive reserve that can postpone the clinical manifestation of dementia. Unhealthy lifestyles may independently contribute to the depletion of this reserve or directly influence the underlying pathologic processes.

Nürnberger-Altersinventar

Jan 1986

W D Oswald
U M Fleischmann

Oswald, W.D., Fleischmann, U.M., 1986. Nürnberger-Altersinventar. Universität Erlangen-Nürnberg, Erlangen-Nürnberg.

SKID: Strukturiertes klinisches Interview für DSM-III-R

Jan 1991

H U Wittchen
M Zaudig
P Sprengler

Wittchen, H.U., Zaudig, M., Sprengler, P., 1991. SKID: Strukturiertes klinisches Interview für DSM-III-R. Weinheim, Beltz Test.

The Trail Making Test: Manual for Administration and Scoring. The Reitan Neuropsychological Laboratory Classification criteria for mild cognitive impairment: a population-based validation study

Jan 1992
37-42

C Reitan

Reitan, C., 1992. The Trail Making Test: Manual for Administration and Scoring. The Reitan Neuropsychological Laboratory, Tucson. Ritchie, K., Artero, S., Touchon, J., 2001. Classification criteria for mild cognitive impairment: a population-based validation study. Neurology 56, 37–42.

Wechsler Gedächtnistest -revidierte Fassung. Deutsche Adaption der revidierten Fassung der Wechsler memory scale

Jan 2000

D Wechsler

Wechsler, D., 2000. Wechsler Gedächtnistest -revidierte Fassung. Deutsche Adaption der revidierten Fassung der Wechsler memory scale. Huber, Bern.

Influence of leisure activity on the incidence of Alzheimer's disease

Jan 2001
NEUROLOGY
2236-2242

N Scarmeas
G Levy
M.-X Tang
J Manly
Y Stern

Scarmeas, N., Levy, G., Tang, M.-X., Manly, J., Stern, Y., 2001. Influence of leisure activity on the incidence of Alzheimer's disease. Neurology 57, 2236-2242.

Influence of leisure activity on the incidence of Alzheimer's disease

Jan 2001
2236

Scarmeas

Wechsler Gedächtnistest — revidierte Fassung

Jan 2000

Wechsler

Cognitive activity, education and socioeconomic status as preventive factors for mild cognitive impairment and Alzheimer's disease

Abstract

No full-text available

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