Late life leisure activities and risk of cognitive decline Wang, Hui-Xin; Jin, Yinlong; Hendrie, Hugh C ...
The journals of gerontology. Series A, Biological sciences and medical sciences,
02/2013, Letnik:
68, Številka:
2
Journal Article
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Studies concerning the effect of different types of leisure activities on various cognitive domains are limited. This study tests the hypothesis that mental, physical, and social activities have a ...domain-specific protection against cognitive decline.
A cohort of a geographically defined population in China was examined in 2003-2005 and followed for an average of 2.4 years. Leisure activities were assessed in 1,463 adults aged 65 years and older without cognitive or physical impairment at baseline, and their cognitive performances were tested at baseline and follow-up examinations.
High level of mental activity was related to less decline in global cognition (β = -.23, p < .01), language (β = -.11, p < .05), and executive function (β = -.13, p < .05) in ANCOVA models adjusting for age, gender, education, history of stroke, body mass index, Apolipoprotein E genotype, and baseline cognition. High level of physical activity was related to less decline in episodic memory (β = -.08, p < .05) and language (β = -.15, p < .01). High level of social activity was associated with less decline in global cognition (β = -.11, p < .05). Further, a dose-response pattern was observed: although participants who did not engage in any of the three activities experienced a significant global cognitive decline, those who engaged in any one of the activities maintained their cognition, and those who engaged in two or three activities improved their cognition. The same pattern was observed in men and in women.
Leisure activities in old age may protect against cognitive decline for both women and men, and different types of activities seem to benefit different cognitive domains.
Poststroke depression (PSD) is common after stroke; however, the relationship to poststroke function is inconclusive. Our objectives were to 1) determine the relationship between PSD at baseline (1 ...month poststroke) and function (12 weeks later) and 2) assess the impact of depression improvement on 12-week function among those with depression at baseline.
We completed a secondary analysis of data from a cohort study of participants with and without PSD. We used logistic regression to identify factors associated with 12-week functional dependence for 1) all 367 participants and 2) the 174 participants with PSD.
In the PSD cohort, 3 characteristics were found to be independently associated with 12-week dependence: increased medical comorbidity (odds ratio OR 1.10, 95%confidence interval CI 1.02-1.22), increased stroke severity (OR 1.42, 95% CI 1.19-1.69), and increased baseline depression severity (OR 1.13, 95% CI 1.03-1.23). Depression severity was significantly different between those considered dependent and independent at 12 weeks (entire cohort, PHQ-9 7.31 vs 5.18, p = 0.008; depressed cohort, PHQ-9 9.94 vs 7.27, p = 0.019).
Among study participants with PSD, the severity of depression symptoms at baseline was associated with dependence; however, our results are inconclusive as to whether improvement of depression is independently associated with functional recovery at 12 weeks. Even if the treatment and improvement of PSD does not directly influence functional recovery poststroke, it is essential for PSD to be identified and treated due to its high symptom burden and association with other negative health and social outcomes.
Dementia is an increasing focus for policymakers, civil organizations and multidisciplinary researchers. The most recent descriptive epidemiological research into dementia is enabling investigation ...into how the prevalence and incidence are changing over time. To establish clear trends, such comparisons need to be founded on population-based studies that use similar diagnostic and research methods consistently over time. This narrative Review synthesizes the findings from 14 studies that investigated trends in dementia prevalence (nine studies) and incidence (five studies) from Sweden, Spain, the UK, the Netherlands, France, the USA, Japan and Nigeria. Besides the Japanese study, these studies indicate stable or declining prevalence and incidence of dementia, and some provide evidence of sex-specific changes. No single risk or protective factor has been identified that fully explains the observed trends, but major societal changes and improvements in living conditions, education and healthcare might have favourably influenced physical, mental and cognitive health throughout an individual's life course, and could be responsible for a reduced risk of dementia in later life. Analytical epidemiological approaches combined with translational neuroscientific research could provide a unique opportunity to explore the neuropathology that underlies changing occurrence of dementia in the general population.
The epidemiology and natural history of cognitive impairment that is not dementia is important to the understanding of normal aging and dementia.
To determine the prevalence and outcome of cognitive ...impairment that is not dementia in an elderly African American population.
A two-phase, longitudinal study of aging and dementia. A total of 2212 community-dwelling African American residents of Indianapolis, IN, aged 65 and older were screened, and a subset (n = 351) received full clinical assessment and diagnosis. Subsets of the clinically assessed were seen again for clinical assessment and rediagnosis at 18 and 48 months. Weighted logistic regression was used to generate age-specific prevalence estimates.
The overall rate of cognitive impairment among community-dwelling elderly was 23.4%. Age-specific rates indicate increasing prevalence with increasing age: 19.2% for ages 65 to 74 years, 27.6% for ages 75 to 84 years, and 38.0% for ages 85+ years. The most frequent cause of cognitive impairment was medically unexplained memory loss with a community prevalence of 12.5%, followed by medical illness-associated cognitive impairment (4.0% prevalence), stroke (3.6% prevalence), and alcohol abuse (1.5% prevalence). At 18-month follow-up, 26% (17/66) of the subjects had become demented.
Cognitive impairment short of dementia affects nearly one in four community-dwelling elders and is a major risk factor for later development of dementia.
The prevalence of dementia in subjects 65 years and older in North America is approximately 6%-10%, with Alzheimer's disease (AD) accounting for two-thirds of these cases. If milder cases are ...included, the prevalence rates double. Both causative and associative genes for AD have now been identified. The search for nongenetic risk factors has been less conclusive. Only age and family history of dementia are consistently associated with AD in all studies, but putative, protective agents such as estrogen, nonsteroidal anti-inflammatory agents (NSAIDs), and vitamin E are now undergoing clinical trials.
Oxidative stress has been implicated both in the aging process and in the pathological changes associated with Alzheimer's disease. Antioxidants, which have been shown to reduce oxidative stress in ...vitro, may represent a set of potentially modifiable protective factors for poor memory, which is a major component of the dementing disorders. The authors investigated the association between serum antioxidant (vitamins E, C, A, carotenoids, selenium) levels and poor memory performance in an elderly, multiethnic sample of the United States. The sample consisted of 4, 809 non-Hispanic White, non-Hispanic Black, and Mexican-American elderly who visited the Mobile Examination Center during the Third National Health and Nutrition Examination Survey, a national cross-sectional survey conducted from 1988 to 1994. Memory is assessed using delayed recall (six points from a story and three words) with poor memory being defined as a combined score less than 4. Decreasing serum levels of vitamin E per unit of cholesterol were consistently associated with increasing levels of poor memory after adjustment for age, education, income, vascular risk factors, and other trace elements and minerals. Serum levels of vitamins A and C, β-carotene, and selenium were not associated with poor memory performance in this study. Am J Epidemiol 1999;150:37–44.
CONTEXT Alzheimer disease (AD) represents a major and increasing public health
problem. If populations were identified with significantly lower or higher
incidence rates of AD, the search for risk ...factors in the genesis of AD could
be greatly enhanced. OBJECTIVE To compare incidence rates of dementia and AD in 2 diverse, elderly
community-dwelling populations. DESIGN The Indianapolis-Ibadan Dementia Project, a longitudinal, prospective
population-based study consisting of a baseline survey (1992-1993) and 2 subsequent
follow-up waves after 2 years (1994-1995) and 5 years (1997-1998). Each wave
followed a 2-stage design, with an in-home screening interview followed by
a full diagnostic workup of a subsample of participants based on screening
performance. SETTING AND PARTICIPANTS A total of 2459 community-dwelling Yoruba residents of Ibadan, Nigeria,
without dementia, and 2147 community-dwelling African American residents of
Indianapolis, Ind, without dementia (all aged 65 years or older). The cohorts
were followed up for a mean of 5.1 years and 4.7 years, respectively. MAIN OUTCOME MEASURES Incident cases of dementia and AD in each of the 2 populations. RESULTS The age-standardized annual incidence rates were significantly lower
among Yoruba than among African Americans for dementia (Yoruba, 1.35% 95%
confidence interval {CI}, 1.13%-1.56%; African Americans, 3.24% 95% CI,
2.11%-4.38%) and for AD (Yoruba, 1.15% 95% CI, 0.96%-1.35%; African Americans,
2.52% 95% CI, 1.40%-3.64%). CONCLUSION This is the first report of incidence rate differences for dementia
and AD in studies of 2 populations from nonindustrialized and industrialized
countries using identical methods and the same group of investigators in both
sites. Further explorations of these population differences may identify potentially
modifiable environmental or genetic factors to account for site differences
in dementia and AD.
Previously reported associations between statin use and incident dementia or cognitive decline have been inconsistent. We report the results from a 3-year prospective study on the association of ...statin use on cognitive decline and incident dementia in elderly African Americans.
A community-based cohort of 1,146 African Americans aged 70 and older living in Indianapolis, Indiana, was evaluated in 2001 and 2004. The instrument used for cognitive assessment was the Community Screening Interview for Dementia (CSI-D). Cognitive decline was defined as CSI-D scores measured at 2001 minus scores at 2004. Measurements of low-density lipoprotein cholesterol (LDL-C) and C-reactive protein (CRP) were obtained from baseline blood samples.
Adjusting for age at baseline, gender, education, and the possession of ApoE epsilon 4 allele, baseline statin use was associated with less cognitive decline (p = 0.0177). There were no significant interactions of statin use when LDL-C and CRP were included. Logistic regression with the four independent variables showed that statin use may be associated with a reduction in incident dementia (OR = 0.32; p = 0.0673). Association with cognitive decline was less clear when investigating statin use over time. Significance remained only for those who discontinued prior to follow-up compared to continuous users or users who started after baseline.
The relationship between statin use and cognitive decline is complex and subjected to unknown confounders. This effect may not be associated with the cholesterol lowering or anti-inflammatory action of statins.
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