Article

Lifestyle factors and risk of dementia: Dubbo Study of the elderly

February 2006
The Medical journal of Australia 184(2):68-70

DOI:10.5694/j.1326-5377.2006.tb00120.x

Source
PubMed

Authors:

Jake Simons

The University of Findlay

Yechiel YF Friedlander

Hebrew University of Jerusalem

To identify risk factors for dementia in an elderly Australian cohort. A longitudinal cohort study conducted in Dubbo, NSW. 2805 men and women aged 60 years and older living in the community and initially free of cognitive impairment, first assessed in 1988 and followed for 16 years. Admission to hospital or nursing home with any kind of dementia. There were 115 cases of dementia in 1233 men (9.3/100) and 170 cases in 1572 women (10.8/100). In a proportional hazards model for dementia, any intake of alcohol predicted a 34% lower risk, and daily gardening a 36% lower risk. Daily walking predicted a 38% lower risk of dementia in men, but there was no significant prediction in women. The lowest tertile of peak expiratory flow predicted an 84% higher risk of dementia, the upper tertile of depression score predicted a 50% higher risk. While excess alcohol intake is to be avoided, it appears safe and reasonable to recommend the continuation of moderate alcohol intake in those already imbibing, as well as the maintenance of physical activity, especially daily gardening, in the hope of reducing the incidence of dementia in future years.

The Relationship Between Physical Activity and Dementia: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

Article

Full-text available

Oct 2018

Junga Lee

Physical activity may decrease the risk of dementia; however, conflicting findings exist. The purpose of the current meta-analysis was to investigate the relationship between physical activity and dementia risk based on physical activity type, amount, and intensity, and to propose an effective minimal physical activity amount for older adults. Forty-four studies were selected for the meta-analysis. Participation in high (a total of >2 hours of activity over the course of three sessions per week) and moderate (a total of >1 hour of activity over the course of two sessions per week) amounts of physical activity showed decreased dementia risks compared to physical inactivity. Vigorous exercise, regular exercise, leisure time physical activities, and gardening showed a positive effect toward lowering dementia risk, but walking was not associated with dementia risk. Physically inactive individuals had a higher dementia risk than those who participated in physical activity. Participation in physical activities produces a favorable effect toward lowering dementia risk. Participating in regular physical activity of >1 hour over the course of two sessions per week and avoiding physical inactivity are recommended for lowering dementia risk. [Journal of Gerontological Nursing, 44(10), 22-29.].

Towards productive and socio-natural urban landscapes : tapping urban agriculture’s potential as a tool for sustainable development

Thesis

Full-text available

Dec 2015

Worldwide, the percentage of people living in urban areas will increase from 50% in 2010 to nearly 70% by 2050. While in many parts of the world, human development is expanding rapidly on the urban fringe and at the expense of rural hinterlands, some cities decided to focus on densifying the built environment. Since densification leads to a quantitative reduction of open spaces, the pressure on the remaining ones is significantly increasing. On the one hand, open spaces should meet the requirements of its users, on the other hand, they have to fulfil expectations regarding climate adaptation and operating efficiency. Thus, to satisfy these claims, urban open spaces have to be endowed with multi-functionality. Urban agriculture, in turn, offers indispensable opportunities to solve - or at least deal with - urban challenges regarding sustainability, health, economy, society, urban design and local food supply. Due to its cross-cutting and multi-dimensional nature, it has the potential to meet a good many of requirements on open spaces. Nonetheless, it still inherits a rather low visibility on the agenda of urban planners. This situation could stem from various reasons, whereby a gap in the understanding of urban agriculture’s capability seems to be a major cause. To this day, there exists no comprehensive literature on the subject - neither a holistic view on urban agriculture’s multifaceted benefits nor its impacts on urban open spaces. Thus, the purpose of this study is to tap urban agriculture’s potential and to emphasise its raison d’être in sustainable urban planning.

Scientific Pages Neurodegener Dis

Article

Full-text available

Jan 2017

Sex-Specific Associations Between Depressive Symptoms and Risk for Subsequent Dementia

Article

Jan 2020

Background: An association between depression and an increased risk for subsequent dementia is well-established. Sexspecific associations are understudied yet. Objective: We aimed to investigate sex-specific associations between depressive symptoms and dementia risk. Methods: Longitudinal analyses were conducted in a pooled data set (n = 4,255, mean age = 80 years) of two prospective cohort studies (LEILA 75+, AgeCoDe). Depressive symptoms were harmonized by dichotomized scores of two different depression screening scales using established cutoffs. Transition to dementia was used as outcome in Cox proportional hazards models. Results: Depressive symptoms at baseline were associated with an increased risk for subsequent dementia, and this association was more pronounced in males (interaction of depressive symptoms × sex: HR = 1.64, 95% CI: 1.02-2.64, p = 0.042) in a model adjusted for study, age, and education. After additional adjustment for subjective and objective cognition, depressive symptoms and their interaction with sex (HR = 1.38, 95% CI: 0.85-2.23, p = 0.188) were no longer significantly associated with the risk for subsequent dementia. Sex-stratified analyses showed stronger and significant associations between depressive symptoms and subsequent dementia in men (e.g., HR= 2.10, 95% CI: 1.36-3.23, p = 0.001, compared to HR= 1.28, 95% CI: 1.04-1.58, p = 0.020, in women). Conclusions: Overall, we provide evidence for a stronger association between depression and dementia in men compared to women. Depressive symptoms should be diagnosed, monitored, and treated, not only due to depression, but also with respect to the risk for subsequent dementia, especially in elderly men.

Evaluation of the Elderly Living in the Central Kirşehir Using Standardized Mini-Mental State Examination

Article

May 2017

Gardening for health: A regular dose of gardening

Article

Jun 2018

Richard Thompson

There is increasing evidence that exposure to plants and green space, and particularly to gardening, is beneficial to mental and physical health, and so could reduce the pressure on NHS services. Health professionals should therefore encourage their patients to make use of green space and to work in gardens, and should pressure local authorities to increase open spaces and the number of trees, thus also helping to counteract air pollution and climate change.

Gait performance and prefrontal cortex activation during single and dual task walking in older adults with different cognitive levels

Article

Full-text available

Jun 2023

Background Growing evidence shows the cognitive function influences the motor performance. The prefrontal cortex (PFC) as a part of the executive locomotor pathway is also important for cognitive function. This study investigated the differences in motor function and brain activity among older adults with different cognitive levels, and examined the significance of cognition on motor functions. Methods Normal control (NC), individuals with mild cognitive impairment (MCI) or mild dementia (MD) were enrolled in this study. All participants received a comprehensive assessment including cognitive function, motor function, PFC activity during walking, and fear of fall. The assessment of cognitive function included general cognition, attention, executive function, memory, and visuo-spatial. The assessment of motor function included timed up and go (TUG) test, single walking (SW), and cognitive dual task walking (CDW). Results Individuals with MD had worse SW, CDW and TUG performance as compared to individuals with MCI and NC. These gait and balance performance did not differ significantly between MCI and NC. Motor functions all correlated with general cognition, attention, executive function, memory, and visuo-spatial ability. Attention ability measured by trail making test A (TMT-A) was the best predictor for TUG and gait velocity. There were no significant differences in PFC activity among three groups. Nevertheless, the PFC activated more during CDW as compared with SW in individuals with MCI ( p = 0.000), which was not demonstrated in the other two groups. Conclusion MD demonstrated worse motor function as compared to NC and MCI. The greater PFC activity during CDW in MCI may be considered as a compensatory strategy for maintaining the gait performance. Motor function was related to the cognitive function, and the TMT A was the best predictor for the gait related performance in present study among older adults.

Alcohol use, dementia risk, and sex: a systematic review and assessment of alcohol-attributable dementia cases in Europe

Article

Full-text available

Apr 2023
BMC Geriatr

Background High-risk alcohol use is an established modifiable risk factor for dementia. However, prior reviews have not addressed sex differences in alcohol-related dementia risk. In this systematic review, we take a sex-specific perspective towards the alcohol-dementia link, taking into account the age of dementia onset. Methods We searched electronic databases for original cohort or case–control studies investigating the association between alcohol use and dementia. Two restrictions were considered: First, studies had to report results stratified by sex. Second, given the fact that the age at dementia onset seems to affect the alcohol-dementia link, studies were required to distinguish between early-onset and late-onset dementia (cut-off: 65 years). Additionally, the contribution of alcohol to dementia incidence was quantified for a set of 33 European countries for the year 2019. Results We reviewed 3,157 reports, of which 7 publications were finally included and summarised narratively. A lower dementia risk when drinking alcohol infrequent or at moderate levels was found in men (three studies) and women (four studies). High-risk use and alcohol use disorders increased the risk of mild cognitive impairment and dementia, particularly early-onset dementia. Estimating the alcohol-attributable share of incident dementia cases revealed that 3.2% and 7.8% of incident dementia cases were estimated to be attributable to high-risk alcohol use (at least 24 g of pure alcohol per day) in 45-to-64-year-old women and men, respectively. Conclusions Research to date has paid little attention to the sex-specific link of alcohol and dementia. In the absence of sex-specific research, the established recommendations on high-risk alcohol use should be employed to communicate the alcohol-attributable dementia risk.

Futurization of Aging: Subjective Beliefs and Effects

Article

Full-text available

Dec 2022

Aging in the face of an increasing population and growing life expectancy is considered one of the major demographic challenges in modern society. Previous research has revealed that quality of life in aging could significantly differ depending on the resources one possesses. However, little attention has been given to the mechanisms of formation of these resources and the role of intentionality. In the present study, we identified 22 strategies that favor a better life quality in aging and analyzed them from the perspective of subjective beliefs and reported performance. Our sample was adults (n = 72) aged 57–65, living in St. Petersburg, Russia. The results showed that although participants were aware of the strategies that favor aging, their reported performance ranged on a scale from average to infrequent use of these strategies. We found that subjective beliefs about the role of psychological resources for better aging predicted higher scores on subjective beliefs about the role of lifestyle resources and the reported performance of psychological resources. Our results suggest that there is a gap between subjective beliefs about the controllability of aging processes and the transformation of these beliefs into real performance.

Contribution of Home Gardens to Sustainable Development: Perspectives from A Supported Opinion Essay

Article

Full-text available

Oct 2022
Int J Environ Res Publ Health

Home gardening has a long history that started when humans became sedentary, being traditionally considered an accessible source of food and medicinal plants to treat common illnesses. With trends towards urbanization and industrialization, particularly in the post-World War II period , the importance of home gardens as important spaces for growing food and medicinal plants reduced and they began to be increasingly seen as decorative and leisure spaces. However, the growing awareness of the negative impacts of agricultural intensification and urbanization for human health, food quality, ecosystem resilience, and biodiversity conservation motivated the emergence of new approaches concerning home gardens. Societies began to question the potential of nearby green infrastructures to human wellbeing, food provisioning, and the conservation of traditional varieties, as well as providers of important services, such as ecological corridors for wild species and carbon sinks. In this context. and to foster adaptive and resilient social-ecological systems , our supported viewpoint intends to be more than an exhaustive set of perceptions, but a reflection of ideas about the important contribution of home gardens to sustainable development. We envision these humble spaces strengthening social and ecological components, by providing a set of diversified and intermingled goods and services for an increasingly urban population.

Development of a novel dementia risk prediction model in the general population: A large, longitudinal, population-based machine-learning study

Article

Full-text available

Nov 2022

Background The existing dementia risk models are limited to known risk factors and traditional statistical methods. We aimed to employ machine learning (ML) to develop a novel dementia prediction model by leveraging a rich-phenotypic variable space of 366 features covering multiple domains of health-related data. Methods In this longitudinal population-based cohort of the UK Biobank (UKB), 425,159 non-demented participants were enrolled from 22 recruitment centres across the UK between March 1, 2006 and October 31, 2010. We implemented a data-driven strategy to identify predictors from 366 candidate variables covering a comprehensive range of genetic and environmental factors and developed the ML model to predict incident dementia and Alzheimer's Disease (AD) within five, ten, and much longer years (median 11.9 [Interquartile range 11.2–12.5] years). Findings During a follow-up of 5,023,337 person-years, 5287 and 2416 participants developed dementia and AD, respectively. A novel UKB dementia risk prediction (UKB-DRP) model comprising ten predictors including age, ApoE ε4, pairs matching time, leg fat percentage, number of medications taken, reaction time, peak expiratory flow, mother's age at death, long-standing illness, and mean corpuscular volume was established. Our prediction model was internally evaluated based on five-fold cross-validation on discrimination and calibration, and it was further compared with existing prediction scales. The UKB-DRP model can achieve high discriminative accuracy in dementia (AUC 0.848 ± 0.007) and even better in AD (AUC 0.862 ± 0.015). The model was well-calibrated (Hosmer-Lemeshow goodness-of-fit p-value = 0.92), and the predictive power was solid in different incidence time groups. More importantly, our model presented an apparent superiority over existing models like Cardiovascular Risk Factors, Aging, and Incidence of Dementia Risk Score (AUC 0.705 ± 0.008), the Dementia Risk Score (AUC 0.752 ± 0.007), and the Australian National University Alzheimer's Disease Risk Index (AUC 0.584 ± 0.017). The model was internally validated in the general population of European ancestry and White ethnicity; thus, further validation with independent datasets is necessary to confirm these findings. Interpretation Our ML-based UKB-DRP model incorporated ten easily accessible predictors with solid predictive power for incident dementia and AD within five, ten, and much longer years, which can be used to identify individuals at high risk of dementia and AD in the general population. Funding This study was funded by grants from the Science and Technology Innovation 2030 Major Projects (2022ZD0211600), National Key R&D Program of China (2018YFC1312904, 2019YFA070950), National Natural Science Foundation of China (282071201, 81971032, 82071997), Shanghai Municipal Science and Technology Major Project (2018SHZDZX01), Research Start-up Fund of Huashan Hospital (2022QD002), Excellence 2025 Talent Cultivation Program at Fudan University (3030277001), Shanghai Rising-Star Program (21QA1408700), Medical Engineering Fund of Fudan University (yg2021-013), and the 111 Project (No. B18015).

Dementia-Preventing Behavior Awareness and Uptake Rates among Japanese Women in Midlife: A Survey-Based Pilot Study

Article

Full-text available

Aug 2022
Int J Environ Res Publ Health

Lifestyle changes may help prevent dementia. However, the perception and practice of dementia-preventing behaviors remain unclear; understanding both factors is required to help prevent dementia already at early stages. This study aimed to examine the awareness and uptake rates of dementia-preventive behaviors among community-dwelling women aged 40 to 64 years, and their associations with dementia-related anxiety. A self-administered anonymous questionnaire was distributed by mail from January to May 2020. The effective response rate was 20.4% (n = 47). Approximately 60% of the responders had dementia-related anxiety; approximately 80% wanted to prevent dementia. The participants were aware of two or more dementia-preventive behaviors; however, less than 50% of them practiced at least one behavior. The group with dementia-related anxiety was more interested in and aware of dementia prevention methods than the group without the anxiety. Women with greater dementia knowledge also knew more methods of preventing it; however, they were not necessarily implementing the recommended behaviors.

Modelo de predicción de la demencia en adultos mayores de 60 años

Article

Full-text available

Jul 2022

Con el objetivo de determinar el aporte de las variables sociodemográficas, psicosociales y de salud, a un modelo de predicción de la demencia en población adulta mayor, se realizó un análisis secundario con los datos del estudio de “Salud, Bienestar y Envejecimiento. Bogotá, 2012”, con 2000 hombres y mujeres mayores de 60 años de áreas urbanas y rurales de Bogotá. Para seleccionar la muestra, se realizó un muestreo probabilístico, polietápico, de conglomerados y estratificado, basado en el censo nacional del 2005. Se utilizó el cuestionario SABE adaptado para Colombia. De acuerdo al nivel de medición de cada variable y la distribución de los datos, se realizaron análisis univariados y bivariados, con la demencia como variable criterio y como predictoras las variables sociodemográficas, de salud; se incluyeron 30 variables. Se encontró que el 40.1% de la varianza de la demencia es explicada por la edad, nivel educativo y socioeconómico, hipertensión, accidente cerebrovascular, depresión, disfuncionalidad motora, fractura de cadera, salud comparada, víctima de atraco, consumo de alcohol, memoria, autorreporte de memoria y memoria comparada. Los hallazgos ofrecen un modelo estadístico que permite la detección de los factores de riesgo para la demencia y el análisis de los potencialmente modificables para su prevención.

The Pluriversity for Stuck Humxns: A Queer EcoPedagogy & Decolonial School

Chapter

Apr 2021

The Pluriversity for stuck humxns is an exploratory dialogue between early career researchers and established researchers. It responds to the concern that dominant forms of knowledge production are not assisting us to move towards life affirming ways of being and that alternatives are possible. The production of this chapter is one of many new acts towards realising other modes of being and becoming unstuck in scholar activist practice. The chapter begins with an invitation in the form of a poem by Lena Weber, and the resulting text is a response to the poem from multiple contributors from around the world, who imagine transgressive and progressive ‘departments’ of the Pluriversity. Situated amongst the impulses of queer ecopedagogy and drawing on imagination to understand and play with multiple (or diverse) knowledges, the authors explore what nurturing institutions for scholarly training and life may look like, and what might be possible and in fact are possible through our collaborative experience in the act of creating the Pluriversity for stuck humxns. Itself an intersectional being, this chapter is a queer inquiry dedicated to challenging and reframing norms and dogma and to shake up the boundaries of categories and narrowly and often dogmatically employed concepts. The authors break open pedagogy in ways that allowed them to question research practice and instead conceive of a ‘research worthy of their longing’.

The role of green roofs in urban Water-Energy-Food-Ecosystem nexus: A review

Article

Full-text available

Dec 2020

Green roofs are strategic tools that can play a significant role in the creation of sustainable and resilient cities. They have been largely investigated thanks to their high retention capacity, which can be a valid support to mitigate the pluvial flood risk and to increase the building thermal insulation, ensuring energy saving. Moreover, green roofs contribute to restoring vegetation in the urban environment, increasing the biodiversity and adding aesthetic value to the city. The new generation of multilayer green roofs present an additional layer with respect to traditional ones, which allows rainwater to be stored, which, if properly treated, can be reused for different purposes. This paper offers a review of benefits and limitations of green roofs, with a focus on multilayer ones, within a Water-Energy-Food-Ecosystem nexus context. This approach enables the potential impact of green roofs on the different sectors to be highlighted, investigating also the interactions and interconnections among the fields. Moreover, the Water-Energy-Food-Ecosystem nexus approach highlights how the installation of traditional and multilayer green roofs in urban areas contributes to the Development Goals defined by the 2030 Sustainable Agenda.

Altered prefrontal cortex responses in older adults with subjective memory complaints and dementia during dual‐task gait: An fNIRS study

Article

Sep 2020
EUR J NEUROSCI

People with cognitive impairments show deficits during physical performances such as gait, in particular during cognitively-challenging conditions (i.e. dual-task gait [DTG]). However it is unclear if people at risk of dementia, such as those with subjective memory complaints (SMC), also display gait and central deficits associated with DTG. In this study, we investigated the effects of single- and dual-task gait (STG and DTG), on left prefrontal cortex (PFC) activation in elderly people with subjective memory complaints (SMC) and Dementia. 58 older adults (aged 65-94 yrs; 26 Healthy; 23 SMC; 9 Dementia) were recruited. Gait spatiotemporal characteristics (i.e. stride velocity and length) were assessed using an instrumented walkway during STG and DTG. Single-channel functional near-infrared spectroscopy over the left PFC was used to measure changes in oxyhaemoglobin (O2 Hb) during gait. Stride velocity and length during STG (all p<0.05) and DTG (all p<0.000) were significantly impaired in people with Dementia compared to Healthy and SMC individuals. No differences were observed between Healthy and SMC. For STG, a greater increase in O2 Hb (p<0.05) was observed in those with Dementia compared to the Healthy and SMC, while no differences were observed between Healthy and SMC. A significant increase and decline in O2 Hb was observed during DTG in the SMC and Dementia groups respectively, compared to Healthy. Our findings indicate an altered pattern of cerebral haemodynamic response of the left PFC in DTG in people with SMC and Dementia, which may suggest that central changes precede functional impairments in people with SMC.

A Training Effect by Three-Month Watering on the Frontal Pole Activation of Healthy Older Adults

Article

Full-text available

Jan 2020

Pathways Connecting Late-Life Depression and Dementia

Article

Full-text available

Mar 2020

Late-life depression is associated with significant cognitive impairment. Meta-analyses showed that depression is associated with an increased risk for Alzheimer’s disease (AD) and it might be an etiological factor for AD. Since late-life depression is often connected with cognitive impairment and dementia is usually associated with depressive symptoms, a simple diagnostic approach to distinguish between the disorders is challenging. Several overlapping pathophysiological substrates might explain the comorbidity of both syndromes. Firstly, a stress syndrome, i.e., elevated cortisol levels, has been observed in up to 70% of depressed patients and also in AD pathology. Stress conditions can cause hippocampal neuronal damage as well as cognitive impairment. Secondly, the development of a depression and dementia after the onset of vascular diseases, the profile of cerebrovascular risk factors in both disorders and the impairments depending on the location of cerebrovascular lesions, speak in favor of a vascular hypothesis as a common factor for both disorders. Thirdly, neuroinflammatory processes play a key role in the etiology of depression as well as in dementia. Increased activation of microglia, changes in Transforming-Growth-Factor beta1 (TGF-beta1) signaling, production of pro-inflammatory cytokines as well as reduction of anti-inflammatory molecules are examples of common pathways impaired in dementia and depression. Fourthly, the neurotrophin BDNF is highly expressed in the central nervous system, especially in the hippocampus, where it plays a key role in the proliferation, differentiation and the maintenance of neuronal integrity throughout lifespan. It has been associated not only with antidepressant properties but also a reduction of cognitive impairment and therefore could be involved also in AD. Another etiologic factor is amyloid accumulation, as plasma amyloid beta-42 independently predicts both late-onset depression and AD. Higher plasma amyloid beta-42 predicts the development of late onset depression and conversion to possible AD. However, clinical trials with antibodies against beta amyloid recently failed, i.e., Solanezumab, Aducanumab, and Crenezumab. An overproduction of amyloid-beta might simply reflect a form of synaptic plasticity to compensate for neuronal dysfunction in different kind of neurological and psychiatric diseases of multiple etiologies. The tau hypothesis, sex/gender specific differences, epigenetics and the gut microbiota-brain axis imply other potential common pathways connecting late-life depression and dementia. In conclusion, different potential pathophysiological links between dementia and depression highlight several specific synergistic and multifaceted treatment possibilities, depending on the individual risk profile of the patient.

Lifestyle Behaviours and Mental Health Outcomes of Elderly: Modification of Socio-Economic and Physical Health Effects

Article

Full-text available

Mar 2021
Ageing Int

Lifestyle behaviours and its mediating relationships between socio-economic characteristics and physical health effects have been widely discussed in epidemiological study. Considering a proper study framework, the relationship between lifestyle and mental health has not been rigorously established. Utilizing population based elderly data from Building a Knowledge Base on Population Ageing in India (BKPAI), present study has made an attempt to understand the direct and indirect effects of lifestyle behaviours on the mental health outcomes of elderly through statistical path. Six lifestyle behaviours were examined: physical activity, smoking, alcohol consumption, diet, family relation and social activity. In order to measure mental health, two common symptoms of general psychological stress including anxiety and depression were identified by examining factor structure of twelve item General Health Questionnaire (GHQ-12) in Indian elderly. The result shows that anxiety and depression were more common among the elderly with unhealthy lifestyle such as physical inactivity, regular smoking, social isolation and poor family relation. Multivariate analysis also shows, poor physical health, characterised by functional limitation, presence of NCDs, and disability has a stronger influence on anxiety and depression. Moderation analysis suggests that both physical activity and social activity have a moderation effect on anxiety and depression over socio-economic risk factors. This study evidently concludes that unhealthy lifestyle behaviours of older adults such as regular smoking, low level of physical activity are directly vis-à-vis indirectly associated with bad mental health. Therefore, modification of these unhealthy lifestyle behaviours will effectively reduce the burden of psychological distress among older adults in India.

Cross-Sectional and Longitudinal Associations between Peak Expiratory Flow and Frailty in Older Adults

Article

Full-text available

Nov 2019

Peak expiratory flow (PEF) has been linked to several health-related outcomes in older people, but its association with frailty is still unclear. This study investigates the association between PEF and prevalent and incident frailty in older adults. Data come from 2559 community-dwelling participants (age ≥ 60 years) of the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). Baseline PEF was expressed as standardized residual (SR) percentiles. Frailty was assessed at baseline and over six years, according to the Fried criteria. Associations between PEF and frailty were estimated cross-sectionally through logistic regressions, and longitudinally by multinomial logistic regression, considering death as alternative outcome. Obstructive respiratory diseases and smoking habits were treated as potential effect modifiers. Our cross-sectional results showed that the 10th–49th and <10th PEF SR percentile categories were associated with three- and five-fold higher likelihood of being frail than the 80th–100th category. Similar estimates were confirmed longitudinally, i.e., adjusted OR = 3.11 (95% CI: 1.61–6.01) for PEF SR percentiles < 10th, compared with 80th–100th percentiles. Associations were enounced in participants without physical deficits, and tended to be stronger among those with baseline obstructive respiratory diseases, and, longitudinally, also among former/current smokers. These findings suggest that PEF is a marker of general robustness in older adults, and its reduction exceeding that expected by age is associated with frailty development.

A Review on Closer Linkage of Human Well Being Indices with Gardening and Recreational Nature

Article

Full-text available

Aug 2019

To change or not to change? Determinants of changing lifestyle and health behaviour for dementia risk reduction

Thesis

Jan 2015

Sarang Kim

Behavioural and lifestyle changes are something we all try to achieve at least once in our lives. However, not everyone successfully carries out or maintains the changes we intend to make. Health behavioural and lifestyle changes for dementia risk reduction may appear to be harder to make as the changes have to be made early in our lives (most effectively in mid-life or earlier) and the changes need to be maintained for a longer period of time (until late-life). In addition, the changes need to be multi-domain as one specific lifestyle and health behaviour change may not be effective in dementia risk reduction. Health behaviour and lifestyle factors that reduce the risk of, and increase the protection from developing dementia have been identified. However, motivations for changing lifestyle and health behaviours, as well as whether the actual health behaviour and lifestyle changes are made have yet to be identified. This thesis explores the determinants of behavioural and lifestyle changes for dementia risk reduction. The broad substantive aims of this thesis are: 1) to better understand potential consumers of dementia risk reduction interventions, 2) to develop a scale assessing beliefs and attitudes about lifestyle and health behavioural changes for dementia risk reduction, 3) to identify predictors of intentions to change lifestyle and health behaviour for dementia risk reduction, 4) to examine attitudes towards dementia compared to other common chronic diseases, and 5) to identify the determinants of health behavioural and lifestyle changes for dementia risk reduction. Five sub-studies have been conducted to achieve the aims of this thesis. The first study, a focus group study, investigates motivators and barriers for intentions to change lifestyle and health behaviours for dementia risk reduction. This study also examines potential consumers' knowledge of, and perception towards dementia. The second study involves the development of a scale based on the Health Belief Model. The third study tests the applicability of this scale on intentions to change lifestyle and health behaviours. The fourth study conducts a cross-national investigation examining people's attitude towards dementia and their willingness to make lifestyle and health behavioural changes for dementia compared to other chronic diseases. Finally, the fifth study assesses determinants of intentions as well as actual health behavioural and lifestyle changes for dementia risk reduction among individuals with increased risk. This thesis is the first of its kind attempting to use a theoretically driven scale to understand potential intervention users' beliefs and attitudes about health behaviour and lifestyle changes for dementia risk reduction. The findings suggest that the determinants for behavioural and lifestyle changes were different from determinants for intentions to change lifestyle and health behaviour for dementia risk reduction. People with high intentions do not necessarily change their health behaviour and lifestyle for dementia risk reduction as well. It was also suggested that the motivations/predictors of behaviour and lifestyle changes for dementia risk reduction differ between males and females. Therefore, it would be cost effective and more accurate to take gender differences into consideration when designing interventions in dementia prevention.

Depressive symptoms in relation to clinical symptom onset of mild cognitive impairment

Article

Oct 2018

Objective There is increasing evidence of an association between depressive symptoms and mild cognitive impairment (MCI) in cross-sectional studies, but the longitudinal association between depressive symptoms and risk of MCI onset is less clear. The authors investigated whether baseline symptom severity of depression was predictive of time to onset of symptoms of MCI. Method These analyses included 300 participants from the BIOCARD study, a cohort of individuals who were cognitively normal at baseline (mean age = 57.4 years) and followed for up to 20 years (mean follow-up = 2.5 years). Depression symptom severity was measured using the Hamilton Depression Scale (HAM-D). The authors assessed the association between dichotomous and continuous HAM-D and time to onset of MCI within 7 years versus after 7 years from baseline (reflecting the mean time from baseline to onset of clinical symptoms in the cohort) using Cox regression models adjusted for gender, age, and education. Results At baseline, subjects had a mean HAM-D score of 2.2 (SD = 2.8). Higher baseline HAM-D scores were associated with an increased risk of progression from normal cognition to clinical symptom onset ≤ 7 years from baseline ( p = 0.043), but not with progression > 7 years from baseline ( p = 0.194). These findings remained significant after adjustment for baseline cognition. Conclusions These results suggest that low levels of depressive symptoms may be predictive of clinical symptom onset within approximately 7 years among cognitively normal individuals and may be useful in identifying persons at risk for MCI due to Alzheimer’s disease.

Longitudinal study of health, disease and access to care in rural Victoria: The Crossroads-II study: Methods

Article

Full-text available

May 2018
BMC PUBLIC HEALTH

Background: High quality, contemporary data regarding patterns of chronic disease is essential for planning by health services, policy makers and local governments, but surprisingly scarce, including in rural Australia. This dearth of data occurs despite the recognition that rural Australians live with high rates of ill health, poor health behaviours and restricted access to health services. Crossroads-II is set in the Goulburn Valley, a rural region of Victoria, Australia 100-300 km north of metropolitan Melbourne. It is primarily an irrigated agricultural area. The aim of the study is to identify changes in the prevalence of key chronic health conditions including the extent of undiagnosed and undermanaged disease, and association with access to care, over a 15 year period. Methods/design: This study is a 15 year follow up from the 2000-2003 Crossroads-I study (2376 households participated). Crossroads-II includes a similar face to face household survey of 3600 randomly selected households across four towns of sizes 6300 to 49,800 (50% sampled in the larger town with the remainder sampled equally from the three smaller towns). Self-reported health, health behaviour and health service usage information is verified and supplemented in a nested sub-study of 900 randomly selected adult participants in 'clinics' involving a range of additional questionnaires and biophysical measurements. The study is expected to run from October 2016 to December 2018. Discussion: Besides providing epidemiological and health service utilisation information relating to different diseases and their risk factors in towns of different sizes, the results will be used to develop a composite measure of health service access. The importance of access to health services will be investigated by assessing the correlation of this measure with rates of undiagnosed and undermanaged disease at the mesh block level. Results will be shared with partner organisations to inform service planning and interventions to improve health outcomes for local people.

What makes a garden in the elderly care facility well used?

Article

Full-text available

Apr 2018

Along with the worldwide ageing process, quality of life for those older people who live in care facilities has received increasing attention. Although gardens have been shown to contribute to the quality of life in various ways, and are commonly provided, they can hardly help much if not well used. Therefore, this study was carried out to identify factors in garden establishment and operation that influence garden usage in elderly care facilities. Face-to-face interviews with management, elderly residents and staff, together with continuous unobtrusive observations, were conducted in two elderly care facilities in Hong Kong. Findings suggest that scale of the facility and garden, location of the garden, attitudes towards the garden among residents, as well as support from staff are influential in garden usage in elderly care facilities. Suggestions to optimise garden usage are provided accordingly.

Depression Severity in Relation to Clinical Symptom Onset in Mild Cognitive Impairment

Article

Mar 2018
AM J GERIAT PSYCHIAT

Effects of Bioactive Components of Green Tea on Alzheimer's Disease

Chapter

Jan 2018

The incidence of Alzheimer's disease (AD) is gradually increasing worldwide. As no fundamental curative therapy has been developed thus far, the prevention and attenuation of AD progression remain primary concerns in clinical practice. Thus, a combination of pharmaceutical and nonpharmaceutical approaches, such as nutritional interventions, is essential to maintain the quality of life of individuals with AD. Green tea components, including catechins and theanine, have the potential for use as such nutritional agents. In vitro and in vivo experimental studies have demonstrated several potential mechanisms and structure–activity relationships of these components. Bioactive green tea components reportedly have antioxidant and antiinflammatory activities, induce protein kinase C activation, inhibit acetylcholine esterase activity, and modulate other neurotransmission systems (e.g., GABAergic, glutamatergic, dopaminergic, and serotonergic neurotransmission). In addition, recent in silico modeling studies have predicted their structure-based activity. The aim of this chapter was to provide an overview of the bioactive components of green tea and their structure–activity relationships with respect to AD prevention and reduced progression. Additionally, a summary of the results from clinical studies has been provided to highlight their effects in humans.

A RESEARCH ON GARDEN/NATURE PERCEPTION OF ELDERLY PEOPLE: CASE OF DENİZLİ / “Yaşlıların Doğa/Bahçe Algıları Üzerine Bir Araştırma: Denizli Örneği”,

Article

Full-text available

Jan 2015

Recently nature and garden show equivalent to the concept quality of life. Human is intertwined with nature the quality of life and well-being has been identified by several studies to affect positively. The purpose of this study is understanding perception about nature/garden in this industrial and developing technology world from the people who lived in past. This study was conducted to identify the perception of nature/garden of people who are 65 or older. That research was made in Denizli in September-October 2014 and it included 301 people. 164 of these people live in rural areas and the remaining 137 live in cities. %93.7 of old people stated that nature affects their psychology positively. They also think that nature increase their joy of life, (%79.9 rural, %77.4 city) protects the body health and increase the strength (%71.3 rural, %63.5 city) and makes them relax (%95.7 of both rural and city). %79.1 of elderly people feels better after spending time in nature/garden. Based on these results; the elderly people are prefer natural places and they think nature has positive effects on people’s life although they living in different socio-demographic and socio-cultural areas. Area where the elderly people being live have different socio demographic and socio-cultural features although they prefer the natural environment, there seem to be a positive influence on the nature of people. According to this knowledge’s hold, protect and replace natural places where the elderly people can make different activities. Keywords: Elderly, Healthy aging, Nature, Garden, Perception, Denizli. Son zamanlarda doğa ve bahçe kavramları yaşam kalitesi kavramı ile eşdeğerde görülmektedir. İnsanın doğa ile iç içe olmasının yaşam kalitesini ve refahını olumlu yönde etkilediği birçok çalışma ile tespit edilmiştir. Bu çalışmanın amacı, endüstrinin ve teknolojinin arttığı günümüzde geçmişte doğayı yaşama şansına sahip olan insanların doğa/bahçe algı ve anlayışlarının ne olduğunu tespit etmektir. Bu doğrultuda çalışma Eylül-Ekim 2014 tarihleri arasında Denizli’de örneklemi 164’ü kırsalda, 137’si kentte yaşayan toplamda 301 olmak üzere 65 yaş ve üzeri bireylerle yüz yüze anket çalışması ile tamamlanmıştır. Yaşlıların %93.7’si doğanın psikolojik olarak olumlu etki yarattığını ifade etmişlerdir. Doğanın/bahçenin; yaşam sevincini arttırdığını (%79.9’u kır, %77.4’ü kent), beden fonksiyonlarını koruyup güçlendirdiğini (%71.3’ü kır, %63.5’i kent), dinlenme ve rahatlama (%95.7’si kır, %95.7’si kent) sağladığını belirtmişlerdir. Yaşlıların %79.1’i doğada/bahçede vakit geçirdikten sonra kendilerini iyi hissetmektedirler. Bu sonuçlar doğrultusunda; yaşlıların bulundukları bölge, sosyo-demografik ve sosyokültürel özellikleri farklı olmasına karşın doğal ortamı tercih ettikleri ve doğanın insan üzerine olumlu yönde etkisinin olduğu düşüncesine sahip oldukları görülmektedir. Bu bilgi günümüzde sağlıklı ve aktif yaşlanmaya katkı sağlayacak farklı aktivitelerin gerçekleştirilecek doğal ortamlarının korunması veya yeniden oluşturulması gereğine işaret etmektedir.

Gardening May Repeatedly Activate the Frontal Pole

Article

Full-text available

Jan 2017

Protective Role of Recent and Past Long-Term Physical Activity on Age-Related Cognitive Decline: The Moderating Effect of Sex

Article

Full-text available

Sep 2017

This study aimed to investigate if the impact of both recent and long-term physical activity on age-related cognitive decline would be modified by sex. One hundred thirty-five men (N = 67) and women (N = 68) aged 18 to 80 years completed the Modifiable Activity Questionnaire and the Historical Leisure Activity Questionnaire. A composite score of cognitive functions was computed from five experimental tasks. Hierarchical regression analyses performed to test the moderating effect of recent physical activity on age-cognition relationship had not revealed significant result regardless of sex. Conversely, past long-term physical activity was found to slow down the age-related cognitive decline among women (β = .22, p = .03), but not men. The findings support a lifecourse approach in identifying determinants of cognitive aging and the importance of taking into account the moderating role of sex. This article presented potential explanations for these moderators and future avenues to explore.

Leisure Activities as a Predictor of Cognitive Decline and Dementia in Old Age

Article

Full-text available

Jan 2017

Dementia is a growing medical and social problem with a devastating impact on the people affected and their respective families/care-takers. Therefore, having knowledge of the relationship between leisure activities with the dementia framework may be of extreme importance in early preventative diagnosis. In this project, by means of a transversal design, an empirical study was carried out to evaluate the principal effects of leisure in dementia development. The project included the participation of 61 elderly persons, 23 clinically diagnosed with dementia and 38 without a clinical diagnosis of dementia. This research takes into consideration one moment of the evaluation; the information having been gathered using evaluation instruments selected to this effect: Sociodemographic Questionnaire, Mini Mental State Exam, Portuguese Version, and Clinical Dementia Rating, Portuguese Version. From the results, it is highlighted that 1) leisure activities seem to be a protection factor in the development of dementia; and 2) leisure emerges as a predictor variable. The interpretation of the results, as well as their possible implications with regard to prevention and treatment, are discussed in light of the relevant literature.

TeleWalk: A Primary Care Telephone Counseling Trial Of Walking In Older Adults

Article

May 2005

Supplementary appendix

Article

Full-text available

Aug 2023

Nelsensius Klau Fauk

Associations of Lung Function Decline with Risks of Cognitive Impairment and Dementia: A Meta-Analysis and Systematic Review

Article

Feb 2023
J ALZHEIMERS DIS

Background: There are controversies surrounding the effects of lung function decline on cognitive impairment and dementia. Objective: We conducted a meta-analysis and systematic review to explore the associations of lung function decline with the risks of cognitive impairment and dementia. Methods: The PubMed, EMBASE, and the Cochrane Library were searched to identify prospective studies published from database inception through January 10, 2023. We pooled relative risk (RR) and 95% confidence intervals (CI) using random-effects models. The Egger test, funnel plots, meta-regression, sensitivity, and subgroup analyses were conducted to detect publication bias and investigate the source of heterogeneity. Results: Thirty-three articles with a total of 8,816,992 participants were subjected to meta-analysis. Poorer pulmonary function was associated with an increased risk of dementia (FEV: RR = 1.25 [95% CI, 1.17-1.33]; FVC: RR = 1.40 [95% CI, 1.16-1.69]; PEF: RR = 1.84 [95% CI, 1.37-2.46]). The results of the subgroup analyses were similar to the primary results. Individuals with lung diseases had a higher combined risk of dementia and cognitive impairment (RR = 1.39 [95% CI, 1.20-1.61]). Lung disease conferred an elevated risk of cognitive impairment (RR = 1.37 [95% CI, 1.14-1.65]). The relationship between lung disease and an increased risk of dementia was only shown in total study participants (RR = 1.32 [95% CI, 1.11-1.57]), but not in the participants with Alzheimer's disease (RR = 1.39 [95% CI, 1.00-1.93]) or vascular dementia (RR = 2.11 [95% CI, 0.57-7.83]). Conclusion: Lung function decline was significantly associated with higher risks of cognitive impairment and dementia. These findings might provide implications for the prevention of cognitive disorders and the promotion of brain health.

Association of periodontitis and oral microbiomes with Alzheimer’s disease: A narrative systematic review

Article

Full-text available

Jul 2022
J DENT SCI

Background/purpose Alzheimer’s disease (AD) is a neurodegenerative disorder and the most common form of dementia. The etiology for AD includes age, genetic susceptibility, neuropathology, and infection. Periodontitis is an infectious and inflammatory disease which mainly causes alveolar bone destruction and tooth loss. The evidence of a link between AD and periodontitis remains controversial. Thus far, studies reviewing the association between AD and periodontal disease have been insufficient from the viewpoint of the oral microbiome. The aim of this review was to focus on studies that have explored the relationship between the oral microbiome and AD development by using the next-generation sequencing technique. Materials and methods A comprehensive electronic search of MEDLINE via PubMed, EMBASE, Scopus, and Google Scholar was conducted. The keywords included dementia, Alzheimer’s disease, cognitive impairment, periodontitis, periodontal disease, and oral microbiome. Results This review included 26 articles based on the eligibility criteria. Epidemiologic researches and post-mortem studies showed that the presence of periodontitis is associated with cognitive decline, suggesting a possible role of periodontal pathogens in the pathogenesis of AD. The reported microbiome was inconsistent with those in gene sequencing studies. Nevertheless, Gram-negative species may be possible candidates. Conclusion This review suggests that periodontal infection is associated with AD. The contributing microbiome remains unconfirmed, possibly because of different microbiome sampling sites or methods. Additional large-scale studies with periodontal intervention and longitudinal follow-up are warranted to clarify the relationship between periodontal disease and AD.

Physical activity as a protective factor for dementia and Alzheimer’s disease: systematic review, meta-analysis and quality assessment of cohort and case–control studies

Article

Full-text available

Mar 2022

Objective Physical activity (PA) is associated with a decreased incidence of dementia, but much of the evidence comes from short follow-ups prone to reverse causation. This meta-analysis investigates the effect of study length on the association. Design A systematic review and meta-analysis. Pooled effect sizes, dose–response analysis and funnel plots were used to synthesise the results. Data sources CINAHL (last search 19 October 2021), PsycInfo, Scopus, PubMed, Web of Science (21 October 2021) and SPORTDiscus (26 October 2021). Eligibility criteria Studies of adults with a prospective follow-up of at least 1 year, a valid cognitive measure or cohort in mid-life at baseline and an estimate of the association between baseline PA and follow-up all-cause dementia, Alzheimer’s disease or vascular dementia were included (n=58). Results PA was associated with a decreased risk of all-cause dementia (pooled relative risk 0.80, 95% CI 0.77 to 0.84, n=257 983), Alzheimer’s disease (0.86, 95% CI 0.80 to 0.93, n=128 261) and vascular dementia (0.79, 95% CI 0.66 to 0.95, n=33 870), even in longer follow-ups (≥20 years) for all-cause dementia and Alzheimer’s disease. Neither baseline age, follow-up length nor study quality significantly moderated the associations. Dose–response meta-analyses revealed significant linear, spline and quadratic trends within estimates for all-cause dementia incidence, but only a significant spline trend for Alzheimer’s disease. Funnel plots showed possible publication bias for all-cause dementia and Alzheimer’s disease. Conclusion PA was associated with lower incidence of all-cause dementia and Alzheimer’s disease, even in longer follow-ups, supporting PA as a modifiable protective lifestyle factor, even after reducing the effects of reverse causation.

Application of horticultural therapists’ expertise to lectures for dementia prevention: a case report of a dementia prevention course held by a local women’s group in Japan

Article

Nov 2021

Gardening programs based on METs and HR values are needed to prevent dementia in elderly people requiring support

Article

Nov 2021

Recommendations on Alcohol Consumption: An International Comparison

Article

Dec 2007

Creina Stockley

Public health policy on alcohol is changing in many countries. This article reviews public health messages with regard to alcohol in Australia, Canada, the United Kingdom (UK) and the United States (US) and highlights the common as well as the different messages delineated. The messages from these four countries are then compared with those of certain other developed and developing countries. Some of the significant differences include definitions of moderate alcohol consumption, the consumption of alcohol by women, underage consumption, and advice to abstainers, which may reflect differences in the characteristics of consumers among countries. Central to the current debate is the concern that incomplete, inconsistent or misleading messages on alcohol consumption could lead to an increase in alcohol abuse, misuse and hence harm, or, conversely, to abstention by particular population groups.

Intergenerational Contact Zones: Place-based Strategies for Promoting Social Inclusion and Belonging

Book

Full-text available

Feb 2020

Respiratory Disease and Lower Pulmonary Function as Risk Factors for Dementia: A Systematic Review With Meta-analysis

Article

Jan 2020

Background: In addition to affecting the oxygen supply to the brain, pulmonary function is a marker of multiple insults throughout life (including smoking, illness, and socioeconomic deprivation). In this meta-analysis of existing longitudinal studies, we tested the hypothesis that lower pulmonary function and respiratory illness are linked to an elevated risk of dementia. Method: We conducted a systematic review of longitudinal studies using PubMed until April 1st, 2019 and, where possible, pooled results in random-effects meta-analyses. Results: We identified eleven studies relating pulmonary function to later dementia risk, and eleven studies of respiratory illness and dementia (including one which assessed both). The lowest quartile of Forced Expiratory Volume in one second (FEV1) compared with the highest was associated with a 1.4-fold (1.46, 95%CI 0.77-2.75) increased dementia risk (Ntotal=62,209, two studies). An decrease of one standard deviation in FEV1 was associated with a 28% increase in dementia risk (1.28, 95%CI 1.03-1.60; Ntotal=67,505; six studies). Respiratory illness was also associated with increased dementia risk to a similar degree (1.54, 1.30-1.81, Ntotal=288,641, 11 studies). Conclusions: Individuals with poor pulmonary function experience increased risk of dementia. The extent to which the association between poor pulmonary function and dementia is causal remains unclear and requires examination.

Einfluss von Lebensstil auf kognitiven Abbau und Demenz: Übersicht zur Evidenzlage aus systematischen Reviews und Metaanalysen

Article

Nov 2019

ZUSAMMENFASSUNG Zusammenfassung Gegenstand und Ziel Da aktuell keine Wunderpille gegen Demenz in Sicht ist, bieten gerade nicht pharmakologische Interventionen vielversprechende Möglichkeiten in der Prävention und Versorgung. Ziel der vorliegenden Arbeit war es, die Evidenzlage zum Einfluss des Lebensstils auf die kognitive Gesundheit im höheren Lebensalter zu eruieren. Material und Methoden In der Datenbank ‚Pubmed‘ wurde nach systematischen Literaturübersichten und Metaanalysen zu kognitiven Aktivitäten, körperlicher Bewegung, sozialen Aktivitäten, Musik, Kunst, Meditation, Religion und Umgang mit Tieren gesucht. Ergebnisse Die Ergebnisse zeigen, dass kognitive, körperliche und soziale Aktivität zu besserer kognitiver Leistungsfähigkeit, selbst bei Personen mit Demenz, und geringerem Demenzrisiko führen können. Tanzen, Meditation, religiöse Aktivitäten und Kunst scheinen ebenso protektiv zu wirken. Die Evidenzlage zu Musik und Tiertherapie ist nicht aussagekräftig. Schlussfolgerung Der Lebensstil kann ein wichtiger Behandlungsfaktor sein, der zur Stabilisierung der kognitiven Fähigkeiten beiträgt und schon frühzeitig als Prävention in die Behandlung einbezogen werden kann. Es empfiehlt sich dringend, Möglichkeiten zu eruieren, um dies zu ermöglichen.

Building on the inherent strengths of green space environments: Promoting trust, democracy, and resilience among ethnically diverse groups

Article

Jun 2019

August Hoffman

This quasi-experimental study examines the psychosocial and ecological impact of community service activities that utilize green space environments (i.e., community gardens, labyrinths, and urban forestry programs) on individual perceptions of the value and relevance of community service learning programs and the democratic processes that are typically associated with the development and maintenance of green space environments. Sixteen (16) volunteers participated in the current study and subjectively reported their experiences (i.e., perceptions in appreciating living things, experiencing a greater kinship with plants and animals; and a sense of belonging to nature) as they experienced a variety of different green space environments (i.e., community gardens, labyrinths, and parks). Participants were interviewed regarding how these experiences shaped their views regarding the importance of nature and green space environments within urban settings and how exposure to green space environments influenced their own personal perceptions of belongingness and connectedness to both their communities and nature itself. Suggestions for future research are offered.

Physical Leisure Activities and their Role in Preventing Dementia: A Systematic Review

Article

Jan 2009

Respiratory disease and lower pulmonary function as risk factors for subsequent dementia: a systematic review with meta-analysis

Preprint

Apr 2019

Background In addition to affecting the oxygen supply to the brain, pulmonary function is a marker of multiple insults throughout life (including smoking, illness, and socioeconomic deprivation). By meta-analysing existing studies, we tested the hypothesis that lower pulmonary function and respiratory illness are linked to an elevated risk of dementia. Aims To review the best available evidence, taken from longitudinal studies, for pulmonary function and respiratory disease as risk factors of dementia. Method We conducted a systematic review of longitudinal studies using PubMed until April 1 st , 2019 and, where possible, pooled results in random-effects meta-analyses. Results We identified eleven studies relating pulmonary function to later dementia risk, and eleven studies of respiratory illness and dementia (including one which studied both). The lowest quartile of lung function measure Forced Expiratory Volume in one second (FEV 1 ) compared with the highest was associated with a 1.5-fold (1.51, 95%CI 0.94-2.42) increased dementia risk (N total =127,710, 3 studies). Respiratory illness was also associated with increased dementia risk to a similar degree (1.54, 1.30-1.81, N total =288,641, 11 studies). Conclusions Individuals with poor pulmonary function are at increased risk of dementia. The extent to which the association between poor pulmonary function and dementia is causal remains unclear.

Stroke and dementia risk: A systematic review and meta-analysis

Article

Aug 2018

Introduction: Stroke is an established risk factor for all-cause dementia, though meta-analyses are needed to quantify this risk. Methods: We searched Medline, PsycINFO, and Embase for studies assessing prevalent or incident stroke versus a no-stroke comparison group and the risk of all-cause dementia. Random effects meta-analysis was used to pool adjusted estimates across studies, and meta-regression was used to investigate potential effect modifiers. Results: We identified 36 studies of prevalent stroke (1.9 million participants) and 12 studies of incident stroke (1.3 million participants). For prevalent stroke, the pooled hazard ratio for all-cause dementia was 1.69 (95% confidence interval: 1.49-1.92; P < .00001; I2 = 87%). For incident stroke, the pooled risk ratio was 2.18 (95% confidence interval: 1.90-2.50; P < .00001; I2 = 88%). Study characteristics did not modify these associations, with the exception of sex which explained 50.2% of between-study heterogeneity for prevalent stroke. Discussion: Stroke is a strong, independent, and potentially modifiable risk factor for all-cause dementia.

Author's manuscript

Data

Full-text available

Oct 2017

Prevention and Reversal of Alzheimer’s Disease

Technical Report

Full-text available

Jan 2017

an in-depth treatise identifying hundreds of causes of “AD” identified by profiling an exhaustive compilation of experimental results from the literature

How does spatial organisation of gardens at care facilities for the elderly influence use patterns: a case study in Hong Kong

Article

Full-text available

Apr 2017

Ageing has received broad attention worldwide. Gardens for the elderly have also received increasing attention as they have been revealed to be beneficial to the elderly’s well-being and quality of life. Based on existing design guidelines for such gardens, the influence of different spatial organisation on use patterns needs further study and discussion. In this article, one garden at a care facility for the elderly was studied through total site factor measurement, resident and staff interviews, along with observations. As indicated by the results and discussions, topographic level changes are found to be more influential than distance and shade. Enclosure of space is also influential on the pattern of use, but needs to be applied carefully for safety concerns. Management is also found to be a flexible and cost-effective approach to modify spatial organisation and further alter use patterns in the garden.

Role of Wine Components in Inflammation and Chronic Diseases

Chapter

Feb 2016

Creina Stockley

Population ageing is occurring on a global scale, with faster ageing projected for the coming decades than has occurred in the past. The protective effect of moderate wine consumption against diseases associated with ageing such as cardiovascular disease, diabetes, neurodegenerative diseases, and certain cancers has been consistently observed over the past decades. All these diseases have an inflammatory component. Improving anti-inflammatory effects and endothelial function by means of drug and non-drug therapies such as moderate wine consumption might represent an important therapeutic target. There is sufficient epidemiological evidence accumulating plausible biological mechanisms to support an anti-inflammatory role for wine and wine-derived phenolic compounds such as resveratrol. Both the alcohol and phenolic components of wine, for example, have been observed to modulate soluble inflammatory mediators in vitro and in vivo. Further research is required to fully elucidate all the anti-inflammatory biological mechanisms of resveratrol and the other wine-derived phenolic compounds given that inflammation is a complex network of molecular and cellular interactions that facilitates a return to physiological homeostasis and tissue repair. A high level of risk factors for any degenerative disease and cancer may, however, mitigate any protective effects of moderate wine consumption.

Leisure activities and the risk of dementia - The authors reply

Article

Full-text available

Sep 2003

Association of diabetes mellitus and dementia: The Rotterdam Study

Article

Full-text available

Dec 1996

Dementia and non-insulin-dependent diabetes mellitus (NIDDM) are highly prevalent disorders in the elderly. Diabetes has repeatedly been reported to affect cognition, but its relation with dementia is uncertain. We therefore studied the association between diabetes and dementia in the Rotterdam Study, a large population-based study in the elderly. Of 6330 participants, aged 55 to 99 years old, complete information on diabetes and presence of dementia was available. Diabetes was diagnosed as use of anti-diabetes medication or random or post-load serum glucose over 11 mmol/1. Dementia was diagnosed through a stepped approach, including a sensitive screening of all participants and a comprehensive diagnostic work-up. Diabetes was present in 724 (11.4%) subjects. Of the 265 dementia patients 59 (22.3%) had diabetes. Multiple logistic regression analyses, adjusting for age and sex differences, revealed a positive association between diabetes and dementia (odds ratio: 1.3, 95% confidence interval 1.0-1.9). In particular, strong associations were found between dementia and diabetes treated with insulin (odds ratio: 3.2, 95% confidence interval: 1.4-7.5) The relation was strongest with vascular dementia but was also observed with Alzheimer's disease. These associations were independent of educational attainment, smoking, body mass index, atherosclerosis, blood pressure and antihypertensive drug treatment, and could not be explained by clinical cerebra infarctions. The results suggest that NIDDM is associated with dementia. Alzheimer's disease may be more frequent in elderly diabetic patients treated with insulin.

Can physical activity improve the mental health of older adults?

Article

Full-text available

Jul 2004
Ann Gen Hosp Psychiatr

The world population is aging rapidly. Whilst this dramatic demographic change is a desirable and welcome phenomenon, particularly in view of people's increasing longevity, it's social, financial and health consequences can not be ignored. In addition to an increase of many age related physical illnesses, this demographic change will also lead to an increase of a number of mental health problems in older adults and in particular of dementia and depression. Therefore, any health promotion approach that could facilitate introduction of effective primary, secondary and even tertiary prevention strategies in old age psychiatry would be of significant importance. This paper explores physical activity as one of possible health promotion strategies and evaluates the existing evidence that supports its positive effect on cognitive impairment and depression in later life.

Alcohol drinking in middle age and subsequent risk of mild cognitive impairment and dementia in old age: A prospective population based study

Article

Full-text available

Oct 2004
Br Med J

To evaluate the relation between midlife alcohol consumption and mild cognitive impairment and dementia in old age, and the possible modification of this relation by apolipoprotein E. Prospective, population based study. Populations of Kuopio and Joensuu, eastern Finland. Of 1464 men and women aged 65-79 years randomly selected from population based samples studied in 1972 or 1977, 1018 (70%) were re-examined in 1998 (after an average follow up of 23 years). Mild cognitive impairment and dementia in old age. Participants who drank no alcohol at midlife and those who drank alcohol frequently were both twice as likely to have mild cognitive impairment in old age as those participants who drank alcohol infrequently. The risk of dementia related to alcohol drinking was modified by the presence of the apolipoprotein e4 allele. The carriers of apolipoprotein e4 had an increased risk of dementia with increasing alcohol consumption: compared with non-carriers who never drank, the odds ratio for carriers who never drank was 0.6, for infrequent drinkers it was 2.3, and for frequent drinkers was 3.6 (the overall interaction term "drinking frequency(*)apolipoprotein e4" was significant (P = 0.04), as were the interactions "infrequent drinking(*)apolipoprotein e4" (P = 0.02) and "frequent drinking(*)apolipoprotein e4" (P = 0.03)). Non-carriers of apolipoprotein e4 had similar odds ratios for dementia irrespective of alcohol consumption. Alcohol drinking in middle age showed a U shaped relation with risk of mild cognitive impairment in old age. Risk of dementia increased with increasing alcohol consumption only in those individuals carrying the apolipoprotein e4 allele.

Walking and Dementia in Physically Capable Elderly Men

Article

Full-text available

Oct 2004
J Am Med Assoc

Evidence suggests that physical activity may be related to the clinical expression of dementia. Whether the association includes low-intensity activity such as walking is not known. To examine the association between walking and future risk of dementia in older men. Prospective cohort study. Distance walked per day was assessed from 1991 to 1993 in 2257 physically capable men aged 71 to 93 years in the Honolulu-Asia Aging Study. Follow-up for incident dementia was based on neurological assessment at 2 repeat examinations (1994-1996 and 1997-1999). Overall dementia, Alzheimer disease, and vascular dementia. During the course of follow-up, 158 cases of dementia were identified (15.6/1000 person-years). After adjusting for age, men who walked the least (<0.25 mile/d) experienced a 1.8-fold excess risk of dementia compared with those who walked more than 2 mile/d (17.8 vs 10.3/1000 person-years; relative hazard [RH], 1.77; 95% confidence interval [CI], 1.04-3.01). Compared with men who walked the most (>2 mile/d), an excess risk of dementia was also observed in those who walked 0.25 to 1 mile/d (17.6 vs 10.3/1000 person-years; RH, 1.71; 95% CI, 1.02-2.86). These associations persisted after accounting for other factors, including the possibility that limited amounts of walking could be the result of a decline in physical function due to preclinical dementia. Findings suggest that walking is associated with a reduced risk of dementia. Promoting active lifestyles in physically capable men could help late-life cognitive function.

Predictors of impaired cognitive function in men over the age of 80 years: results from the Health in Men Study

Article

Full-text available

Feb 2005

Atorvastatin for the Treatment of Mild to Moderate Alzheimer Disease

Article

Full-text available

Jun 2005
ARCH NEUROL-CHICAGO

Laboratory evidence of cholesterol-induced production of amyloid beta as a putative neurotoxin precipitating Alzheimer disease, along with epidemiological evidence, suggests that cholesterol-lowering statin drugs may favorably influence the progression of the disorder. To determine if treatment with atorvastatin calcium affects the cognitive and/or behavioral decline in patients with mild to moderate Alzheimer disease. Pilot intention-to-treat, proof-of-concept, double-blind, placebo-controlled, randomized (1:1) trial with a 1-year exposure to once-daily atorvastatin calcium (80 mg; two 40-mg tablets) or placebo using last observation carried forward analysis of covariance as the primary method of statistical assessment. Individuals with mild to moderate Alzheimer disease (Mini-Mental State Examination score of 12-28) were recruited. Of the 98 participants providing informed consent, 71 were eligible for randomization, 67 were randomized, and 63 subjects completed the 3-month visit and were considered evaluable. The primary outcome measures were change in Alzheimer's Disease Assessment Scale-cognitive subscale and the Clinical Global Impression of Change Scale scores. The secondary outcome measures included scores on the Mini-Mental State Examination, Geriatric Depression Scale, the Neuropsychiatric Inventory Scale, and the Alzheimer's Disease Cooperative Study-Activities of Daily Living Inventory. The tertiary outcome measures included total cholesterol, low-density lipoprotein cholesterol, and very low-density lipoprotein cholesterol levels. Atorvastatin reduced circulating cholesterol levels and produced a positive signal on each of the clinical outcome measures compared with placebo. This beneficial effect reached significance for the Geriatric Depression Scale and the Alzheimer's Disease Assessment Scale-cognitive subscale at 6 months and was significant at the level of a trend for the Alzheimer's Disease Assessment Scale-cognitive subscale, Clinical Global Impression of Change Scale, and Neuropsychiatric Inventory Scale at 12 months assessed by analysis of covariance with last observation carried forward. Atorvastatin treatment may be of some clinical benefit and could be established as an effective therapy for Alzheimer disease if the current findings are substantiated by a much larger multicenter trial.

High cholesterol levels in late life assotiated with a reduced risk of dementia

Article

Full-text available

Jun 2005
NEUROLOGY

To examine the longitudinal association between plasma total cholesterol and triglyceride levels and incident dementia. Neuropsychiatric, anthropometric, laboratory, and other assessments were conducted for 392 participants of a 1901 to 1902 birth cohort first examined at age 70. Follow-up examinations were at ages 75, 79, 81, 83, 85, and 88. Information on those lost to follow-up was collected from case records, hospital linkage system, and death certificates. Cox proportional hazards regression examined lipid levels at ages 70, 75, and 79 and incident dementia between ages 70 and 88. Increasing cholesterol levels (per mmol/L) at ages 70 (hazard ratio [HR] 0.77, 95% CI: 0.61 to 0.96, p = 0.02), 75 (HR 0.70, CI: 0.52 to 0.93, p = 0.01), and 79 (HR 0.73, CI: 0.55 to 0.98, p = 0.04) were associated with a reduced risk of dementia between ages 79 and 88. Examination of cholesterol levels in quartiles showed that the risk reduction was apparent only among the highest quartile at ages 70 (8.03 to 11.44 mmol/L [311 to 442 mg/dL]; HR 0.31, CI: 0.11 to 0.85, p = 0.03), 75 (7.03 to 9.29 mmol/L [272 to 359 mg/dL]; HR 0.20, CI: 0.05 to 0.75, p = 0.02), and 79 (6.82 to 9.10 mmol/L [264 to 352 mg/dL]; HR 0.45, CI: 0.17 to 1.23, p = 0.12). Triglyceride levels were not associated with dementia. High cholesterol in late life was associated with decreased dementia risk, which is in contrast to previous studies suggesting high cholesterol in mid-life is a risk factor for later dementia. The conflicting results may be explained by the timing of the cholesterol measurements in relationship to age and the clinical onset of dementia.

Consistency of Epidemiologic Estimates

Article

Full-text available

Feb 2005

The epidemiology of a disease describes numbers of people becoming incident, being prevalent, recovering, surviving, and dying from the disease or from other causes. As a matter of accounting principle, the inflow, stock, and outflows must be compatible, and if we could observe completely every person involved, the epidemiologic estimates describing the disease would be consistent. Lack of consistency is an indicator for possible measurement error. We examined the consistency of estimates of incidence, prevalence, and excess mortality of dementia from the Rotterdam Study. We used the incidence and excess mortality estimates to calculate with a mathematical disease model a predicted prevalence, and compared the predicted to the observed prevalence. Predicted prevalence is in most age groups lower than observed, and the difference between them is significant for some age groups. The observed discrepancy could be due to overestimates of prevalence or excess mortality, or an underestimate of incidence, or a combination of all three. We conclude from an analysis of possible causes that it is not possible to say which contributes most to the discrepancy. Estimating dementia incidence in an aging cohort presents a dilemma: with a short follow-up border-line incident cases are easily missed, and with longer follow-up measurement problems increase due to the associated aging of the cohort. Checking for consistency is a useful strategy to signal possible measurement error, but some sources of error may be impossible to avoid.

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.

Walking and Dementia in Physically Capable Elderly Men

Article

Dec 2004

Physical Activity, including walking, and cognitive function in older women

Article

Dec 2004

Patterns and predictors of nursing home placement over 14 years: Dubbo Study of Elderly Australians

Article

Aug 2005
AUSTRALAS J AGEING

Objective: To describe patterns and predictors of nursing home placement. Methods: This is a longitudinal study of an elderly cohort living in Dubbo, New South Wales, Australia. A total of 1233 men and 1572 women aged 60 years and older living in the community were examined in 1988 and followed for 14 years. The incidence of nursing home placement and underlying clinical diagnoses were assessed. Results were modelled for baseline predictors of placement using Cox proportional hazards regression. Results: From 2805 subjects in the study there were 244 (8.7%) nursing home placements, 95 in men (7.7%) and 149 in women (9.5%). A total of 44% placements were primarily due to dementia, but dementia was a secondary diagnosis in another 20% of cases. The other principal diagnoses were stroke (16%) and coronary heart disease (14%). Median time to death in a nursing home was 10.5 months in men and 9.0 months in women. In a Cox proportional hazards model using baseline characteristics, the hazard of nursing home placement increased significantly with age (hazard ratio = 1.13), urinary incontinence (1.66), impaired peak expiratory flow (3.19), physical disability (1.59) and depression (1.85). The hazard of placement was significantly reduced by alcohol intake (0.55) and female gender (0.55). Socioeconomic factors were not significant. Conclusions: Dementia and disability-related care burdens rather than other health conditions are the dominant causes of nursing home placement in an unselected elderly community. Risk factors such as incontinence, impaired respiratory function and depression have been identified and these are potentially amenable to intervention.

Vascular Risk and Cognitive Impairment in an Older, British, African‐Caribbean Population

Article

Feb 2003
J AM GERIATR SOC

OBJECTIVES: In an older, British, African‐Caribbean population with high prevalence rates of hypertension and diabetes mellitus, we ascertained clinical vascular disease (stroke or ischemic heart disease) and vascula; risk (including hypertension, diabetes, and lipid profile) and investigated their associations with cognitive impairment. DESIGN: Cross‐sectional community‐based study. SETTING: The sample was drawn from registration lists for seven primary care services in south London, United Kingdom. PARTICIPANTS: 278 individuals, age 55 to 75, who were born in a Caribbean nation. MEASUREMENTS: Participants were interviewed and examined for cardiovascular risk factors, including a blood test for lipid profile and fibrinogen. A battery of 11 psychometric tests was administered blind to medical status. Cognitive impairment was defined on the basis of a composite measure derived from individual test scores. RESULTS: Seventy‐nine (28%) subjects were classified as having relative cognitive impairment and were compared with the remainder of the sample. Marked differences were seen between low and normal/high educational levels in the strength of associations between measures of vascular risk and cognitive impairment. Hypertension, diabetes, and raised triglycerides were significant factors in those with lower levels of education. Low fibrinogen (negatively associated), high cholesterol, and manual occupation were significant factors in those with normal/high levels of education. Physical exercise was negatively associated with adjustment for age, occupation, depression, and physical disability and after excluding subjects with the most severe impairment. CONCLUSION: Measures of vascular risk were associated with relative cognitive impairment in this population. These associations were modified by previous educational attainment. Physical activity was negatively associated with cognitive impairment.

A Short Portable Mental Status Questionnaire for the Assessment of Organic Brain Deficit in Elderly Patients†

Article

Nov 1975

Eric Pfeiffer

Clinicians whose practice includes elderly patients need a short, reliable instrument to detect the presence of intellectual impairment and to determine the degree. A 10-item Short Portable Mental Status Questionnaire (SPMSQ), easily administered by any clinician in the office or in a hospital, has been designed, tested, standardized and validated. The standardization and validation procedure included administering the test to 997 elderly persons residing in the community, to 141 elderly persons referred for psychiatric and other health and social problems to a multipurpose clinic, and to 102 elderly persons living in institutions such as nursing homes, homes for the aged, or state mental hospitals. It was found that educational level and race had to be taken into account in scoring individual performance. On the basis of the large community population, standards of performance were established for: 1) intact mental functioning, 2) borderline or mild organic impairment, 3) definite but moderate organic impairment, and 4) severe organic impairment. In the 141 clinic patients, the SPMSQ scores were correlated with the clinical diagnoses. There was a high level of agreement between the clinical diagnosis of organic brain syndrome and the SPMSQ scores that indicated moderate or severe organic impairment.

Dubbo Study of the elderly: sociological and cardiovascular risk factors at entry

Article

Nov 1991
Aust New Zeal J Med

A prospective study of elderly Australians commenced in 1988 in Dubbo, NSW. Its goals are to identify predictors of mortality, hospitalisation and placement in long-term care, with special focus on risk factors for cardiovascular disease. The study population were non-institutionalised subjects, comprising 1237 males and 1568 females 60 years and over. This report describes the baseline findings: demographic, educational and economic data; tobacco and alcohol usage, self-medication and other habits; medical contacts and past diagnosis; prescribed medication and in study diagnosis; psychosocial variables, functional health and social support; blood lipid and lipoprotein data; blood pressure, spirometry and glucose data; heights and weights. Where comparison has been feasible, the findings in Dubbo closely resemble those obtained from the rest of Australia. The findings presented provide the basis for aetiological studies of future outcomes.

The Dubbo study: An Australian prospective community study of the health of elderly

Article

Jan 1991
Aust New Zeal J Med

The proportion of Australian population over 60 years has risen progressively over the last 40 years and this growth is projected to continue. Major health problems of the elderly include coronary heart disease, cerebro-vascular disease, osteoporosis and fracture. The risk factors for coronary heart disease and stroke in middle-aged subjects have been extensively documented in prospective studies in Australia and elsewhere, and include lipid disorders, hypertension, cigarette smoking, diabetes and family history. Few prospective studies have been targeted exclusively on the elderly and information available with respect to vascular risk factors is fragmentary and contradictory. This is the background to a new prospective study of the health of elderly Australians now under way in Dubbo, NSW. The goals of the Dubbo Study are to identify predictors of mortality, hospitalisation and placement in long-term care, while specific aims are the study of risk factors for chronic diseases and disability. This report describes the study rationale, reasons for selecting Dubbo as the study site, methods and measures, participation rates and demography. The target population included all non-institutionalised subjects 60 years and over, domiciled in Dubbo, and is comprised of 1693 males and 2167 females. The attendance rate for an extensive medical and sociological baseline assessment over a 13 months' period was 73% for both sexes. The prospective study is now in place and within three to five years will be generating definitive information in the elderly.

Education and the Prevalence of Dementia and Alzheimer's Disease

Article

Feb 1993

Robert Katzman

The incidence of dementia: A meta-analysis

Article

Oct 1998

To carry out a meta-analysis of the age-specific incidence of all dementias, including AD and vascular dementia. Several meta-analyses have been carried out on dementia prevalence, but none on its incidence. We used loess-curve fitting to analyze data from 23 published studies reporting age-specific incidence data. The incidence of both dementia and AD rose exponentially up to the age of 90 years, with no sign of leveling off. The incidence rates for vascular dementia varied greatly from study to study, but the trend was also for an exponential rise with age. There was no sex difference in dementia incidence (p = 0.21), but women tended to have a higher incidence of AD in very old age, and men tended to have a higher incidence of vascular dementia at younger ages. East Asian countries had a lower incidence of dementia than Europe (p = 0.0004), and also tended to have a lower incidence of AD. The incidence of dementia rises exponentially to the age of 90 years. Any sex differences are small, and incidence is lower in East Asia than in Europe.

Apolipoprotein E and ALzheimer's Disease: The Tip of the Susceptibility Iceberg

Article

Nov 1998

Allen Roses

Apolipoprotein E (APOE) is a true susceptibility polymorphism of the common form of Alzheimer's disease (AD). There are three APOE alleles (ɛ2, ɛ3, ɛ4) that are universally distributed in the population with some variation in allele frequency due to racial and ethnic differences, and are associated with different risks and age of onset distributions. In multiple studies, the positive predictive value for symptomatic possible or probable AD patients who carry at least one ɛ4 allele was consistently >95%. Thus, early in the clinical course of dementia, when diagnoses are only 60-70% accurate, the presence of an ɛ4 allele raises the diagnostic accuracy of AD to >95%. With the anticipation of a second major late-onset AD susceptibility locus on chromosome 12, a matrix of relative susceptibility risks in the population raises many ethical and social questions associated with preclinical prediction. The metabolism of apoE (protein) in the brain is a new and exciting area of neurobiology research made relevant by the association with AD. We have constructed transgenic animals using large human genomic fragments containing human APOE on an APOE-deficit mouse background as well as homologous recombination experiments replacing mouse APOE with human APOE promoter elements. The APOE tissue elements, NOT the human APOE gene coding sequence, is associated with the human pattern of intraneuronal apoE immunoreactivity.

Cognitive decline in individuals with high blood pressure: a longitudinal study in the elderly. EVA Study Group. Epidemiology of Vascular Aging

Article

Dec 1999

To examine whether baseline high blood pressure and antihypertensive treatment predicts cognitive decline in elderly individuals. A longitudinal population-based study of elderly individuals (n = 1,373) in Nantes (western France) was undertaken. Individuals 59 to 71 years of age were selected from electoral rolls. High blood pressure at baseline was defined as systolic blood pressure > or =160 mm Hg or diastolic blood pressure > or =95 mm Hg. Cognitive decline was defined as a drop of 4 points or more on the Mini-Mental State Examination between baseline and the 4-year assessment. There is an association between high blood pressure at baseline and cognitive decline at the 4-year assessment (odds ratio, 2.8; 95% CI, 1.6 to 5.0). In participants with high blood pressure, the risk of cognitive decline was 4.3 (95% CI, 2.1 to 8.8) in those without antihypertensive therapy and 1.9 (95% CI, 0.8 to 4.4) in those being treated. In participants with high blood pressure both at baseline and at the 2-year assessment, the risk for untreated participants was 6.0 (95% CI, 2.4 to 15.0) compared with 1.3 (95% CI, 0.3 to 4.9) in treated participants. High blood pressure was associated with cognitive decline. In individuals with high blood pressure, cognitive decline occurred in a relatively short time period and the risk was highest in untreated hypertensive patients.

Vascular risk and cognitive impairment in an older, British, African-Caribbean population

Article

Apr 2001

In an older, British, African-Caribbean population with high prevalence rates of hypertension and diabetes mellitus, we ascertained clinical vascular disease (stroke or ischemic heart disease) and vascular risk (including hypertension, diabetes, and lipid profile) and investigated their associations with cognitive impairment. Cross-sectional community-based study. The sample was drawn from registration lists for seven primary care services in south London, United Kingdom. 278 individuals, age 55 to 75, who were born in a Caribbean nation. Participants were interviewed and examined for cardiovascular risk factors, including a blood test for lipid profile and fibrinogen. A battery of 11 psychometric tests was administered blind to medical status. Cognitive impairment was defined on the basis of a composite measure derived from individual test scores. Seventy-nine (28%) subjects were classified as having relative cognitive impairment and were compared with the remainder of the sample. Marked differences were seen between low and normal/high educational levels in the strength of associations between measures of vascular risk and cognitive impairment. Hypertension, diabetes, and raised triglycerides were significant factors in those with lower levels of education. Low fibrinogen (negatively associated), high cholesterol, and manual occupation were significant factors in those with normal/high levels of education. Physical exercise was negatively associated with cognitive impairment: an association that persisted after adjustment for age, occupation, depression, and physical disability and after excluding subjects with the most severe imipairment. Measures of vascular risk were associated with relative cognitive impairment in this population. These associations were modified by previous educational attainment. Physical activity was negatively associated with cognitive impairment.

Mild Cognitive Impairment

Article

Jan 2003

Context: As public awareness of Alzheimer's disease increases, more people are asking for help and advice about memory problems. Memory complaints may be secondary to psychiatric, psychological, and physical conditions and is an almost universal early symptom of dementia. The concept of amnestic mild cognitive impairment attempts to describe those people in whom memory loss is not of such severity to merit a diagnosis of dementia. The importance of this group of people is not just the need to develop interventions which ameliorate individual suffering but that they represent a population at high risk of developing dementia, especially Alzheimer's disease, and are an appropriate target for dementia prevention strategies. Starting point: K Kantarci and colleagues (Dement Geriatr Cogn Disord 2002; 14: 198-207) looked at the diagnostic accuracy of magnetic-resonance hippocampal volumetry and spectroscopy in patients with mild cognitive impairment, in normal older people, and in patients with Alzheimer's disease. Hippocampal volumes and N-acetyl aspartate/creatine spectroscopy were the most sensitive assessments discriminating people with mild cognitive impairment from Alzheimer's disease. Combination assessments were better at discriminating these two groups from normal controls. The histological underpinning of cognitive symptoms in older people has been demonstrated by the Cognitive Function and Ageing study (Lancet 2001; 357: 169-75), which showed that a third of people with no clinical evidence of dementia had histopathological hallmarks of Alzheimer's disease. WHERE NEXT? 25 million people across the world have dementia. Mild cognitive impairment, if a validated concept, represents an opportunity for preventing dementia. As more information becomes available about the cause of Alzheimer's disease and prospects emerge for prevention, identification of predementia states offers considerable scope to reduce the individual and societal cost of the illness. Continued validation of the criteria for mild cognitive impairment and studies of intervention should be a priority. As more evidence becomes available highlighting the relatively arbitrary nature of dementia diagnosis (based largely on interference with activities) and interventions become available for the prevention of dementia, mild cognitive impairment and related conditions will become more important.

Physical Activity, Including Walking, and Cognitive Function in Older Women

Article

Oct 2004
J Am Med Assoc

Physical activity may help maintain cognitive function in older adults. To examine the relation of long-term regular physical activity, including walking, to cognitive function. Women reported participation in leisure-time physical activities on biennial mailed questionnaires beginning in 1986. We assessed long-term activity by averaging energy expenditures from questionnaires in 1986 through participants' baseline cognitive assessments (1995 to 2001). We used linear regression to estimate adjusted mean differences in baseline cognitive performance and cognitive decline over 2 years, across levels of physical activity and walking. Nurses' Health Study, including 18 766 US women aged 70 to 81 years. Validated telephone assessments of cognition administered twice approximately 2 years apart (1995 to 2001 and 1997 to 2003), including tests of general cognition, verbal memory, category fluency, and attention. Higher levels of activity were associated with better cognitive performance. On a global score combining results of all 6 tests, women in the second through fifth quintiles of energy expenditure scored an average of 0.06, 0.06, 0.09, and 0.10 standard units higher than women in the lowest quintile (P for trend <.001). Compared with women in the lowest physical activity quintile, we found a 20% lower risk of cognitive impairment for women in the highest quintile of activity. Among women performing the equivalent of walking at an easy pace for at least 1.5 h/wk, mean global scores were 0.06 to 0.07 units higher compared with walking less than 40 min/wk (P< or =.003). We also observed less cognitive decline among women who were more active, especially those in the 2 highest quintiles of energy expenditure. Women in the fourth and fifth quintiles had mean changes in global scores that were 0.04 (95% confidence interval, 0.02-0.10) and 0.06 (95% confidence interval, 0.02-0.11) standard units better than those in the lowest quintile. Long-term regular physical activity, including walking, is associated with significantly better cognitive function and less cognitive decline in older women.

Association between Reported Alcohol Intake and Cognition: Results from the Women's Health Initiative Memory Study

Article

Mar 2005
AM J EPIDEMIOL

Some, but not all, observational studies have suggested that moderate levels of alcohol intake may be associated with improved cognitive function and reduced risk of cognitive decline and dementia. The authors of this 1996-2002 study used data from the Women's Health Initiative Memory Study of postmenopausal combination hormone therapy to assess cross-sectional and prospective associations of self-reported alcohol intake with cognitive function. Across 39 US academic medical centers, 4,461 community-dwelling women aged 65-79 years were followed an average of 4.2 years with annual Modified Mini-Mental State Examinations and standardized protocols for detecting mild cognitive impairment and probable dementia. Compared with no intake, intake of > or =1 drink per day was associated with higher baseline Modified Mini-Mental State Examination scores (p < 0.001) and a covariate-adjusted odds ratio of 0.40 (95% confidence interval: 0.28, 0.99) for significant declines in cognitive function. Associations with incident probable dementia and mild cognitive impairment were of similar magnitude but were not statistically significant after covariate adjustment. Associations with intakes of <1 drink per day were intermediate. Moderate levels of alcohol intake may be associated with better cognition and reduced risk of significant cognitive decline; however, confounding associations with unmeasured factors cannot be ruled out.

Impact of smoking, diabetes and hypertension on survival time in the elderly: The Dubbo Study

Article

Apr 2005

To study the impact of various risk factors on survival time in a cohort of elderly Australians. A longitudinal, prospective cohort study conducted in Dubbo, NSW. Participants were men and women aged 60 years or over living in the community, first assessed in 1988-1989 and followed for 15 years. Mortality rates; risk factors; survival times. There were 668 deaths in 1233 men (54%) and 625 deaths in 1572 women (40%). Coronary heart disease was the major cause of death, rates being higher in men than women until age group 80+ years; stroke death rates were similar in both sexes; cancer and respiratory death rates were higher in men than women across all ages. In a proportional hazards model, the independent predictors of mortality were cigarette smoking, diabetes, very high blood pressure (BP), impaired peak expiratory flow (PEF), physical disability, and zero intake of alcohol. Over 15 years, the average reductions in survival time associated with various risk factors, in men and women respectively, were smoking, 22 and 15 months; diabetes, 18 and 18 months; very high BP, 16 and 9 months; impaired PEF, 14 and 17 months; physical disability, 16 and 12 months; zero alcohol intake, 9 and 5 months. Combinations of selected risk factors were associated with a multiplier effect. The reduction in survival time in elderly citizens demonstrated in the presence of smoking, diabetes and hypertension highlights a potential benefit to healthy ageing to be gained from prevention and intervention.

Risk of dementia and alcohol and wine consumption: a review of recent results

Jan 2004
189

Letebbeur L.

14 Letebbeur L. Risk of dementia and alcohol and wine consumption: a review of recent results. Biol Res 2004; 37: 189-193.

Population projections . Australia Canberra: ABS Available at

Jan 2004

Australian Bureau
Statistics

Australian Bureau of Statistics. Population projections. Australia 2003. Canberra: ABS, 2003. Available at: http://www.abs.gov.au (accessed Dec 2005).

Can physical activity improve the mental health of older adults? The Dubbo Study: an Australian prospective community study of the health of elderly

Jan 1990
12-783

Nt Lautenschlager
Op Almeida
L Flicker
A Janca
La Simons
J Mccallum
J Simons

17 Lautenschlager NT, Almeida OP, Flicker L, Janca A. Can physical activity improve the mental health of older adults? Ann Gen Hosp Psych 2004; 3: 12. 18 Simons LA, McCallum J, Simons J, et al. The Dubbo Study: an Australian prospective community study of the health of elderly. Aust N Z J Med 1990; 20: 783-789.

Lifestyle factors and risk of dementia: Dubbo Study of the elderly

Abstract

No full-text available

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