Higher adherence to a Mediterranean-type diet is linked to lower risk for mortality and chronic diseases, but its association with cognitive decline is unclear.
To investigate the association of a ...Mediterranean diet with change in cognitive performance and risk for dementia in elderly French persons.
Prospective cohort study of 1410 adults (> or = 65 years) from Bordeaux, France, included in the Three-City cohort in 2001-2002 and reexamined at least once over 5 years. Adherence to a Mediterranean diet (scored as 0 to 9) was computed from a food frequency questionnaire and 24-hour recall.
Cognitive performance was assessed on 4 neuropsychological tests: the Mini-Mental State Examination (MMSE), Isaacs Set Test (IST), Benton Visual Retention Test (BVRT), and Free and Cued Selective Reminding Test (FCSRT). Incident cases of dementia (n = 99) were validated by an independent expert committee of neurologists.
Adjusting for age, sex, education, marital status, energy intake, physical activity, depressive symptomatology, taking 5 medications/d or more, apolipoprotein E genotype, cardiovascular risk factors, and stroke, higher Mediterranean diet score was associated with fewer MMSE errors (beta = -0.006; 95% confidence interval CI, -0.01 to -0.0003; P = .04 for 1 point of the Mediterranean diet score). Performance on the IST, BVRT, or FCSRT over time was not significantly associated with Mediterranean diet adherence. Greater adherence as a categorical variable (score 6-9) was not significantly associated with fewer MMSE errors and better FCSRT scores in the entire cohort, but among individuals who remained free from dementia over 5 years, the association for the highest compared with the lowest group was significant (adjusted for all factors, for MMSE: beta = -0.03; 95% CI, -0.05 to -0.001; P = .04; for FCSRT: beta = 0.21; 95% CI, 0.008 to 0.41; P =.04). Mediterranean diet adherence was not associated with the risk for incident dementia (fully adjusted model: hazard ratio, 1.12; 95% CI, 0.60 to 2.10; P = .72), although power to detect a difference was limited.
Higher adherence to a Mediterranean diet was associated with slower MMSE cognitive decline but not consistently with other cognitive tests. Higher adherence was not associated with risk for incident dementia.
OBJECTIVES: To study the subtle changes in instrumental activities of daily living (IADLs) over the 10 years preceding the clinical diagnosis of dementia.
DESIGN: Prospective cohort designed in 1988 ...to study cerebral and functional aging.
SETTING: Community‐based study in southwestern France.
PARTICIPANTS: The sample included 104 incident cases of dementia at the 10‐year follow‐up (T10) and 882 subjects free of dementia at the same visit, all forming part of the PAQUID Study.
MEASUREMENTS: Restriction in four IADLs was studied (telephone, transportation, medication, and finances) 2, 5, 7, and 10 years before the T10 visit.
RESULTS: The future dementia cases had greater IADL restrictions 10 years before the clinical diagnosis of dementia and more‐rapid functional deterioration over time. Controlled for age, sex, and education, subjects restricted in at least two IADLs at baseline had a higher risk of dementia 10 years later (odds ratio (OR)=2.59, 95% confidence interval (CI)=1.24–5.38). In finances, difficulty at baseline was a predictor of dementia 10 years later (OR=2.15, 95% CI=1.13–4.08).
CONCLUSION: This study is the first to show that, 10 years before the clinical diagnosis of dementia, subjects who later developed dementia performed worse in complex activities of daily living, which may constitute an early marker of the disease. In practice, restriction in IADLs may be a simple and useful tool for screening subjects at risk of developing dementia in the long term.
Many studies suggest a relationship between excessive daytime sleepiness (EDS) and dementia incidence, but the underlying mechanisms remain uncertain. The study aimed to investigate the role of ...cardiovascular burden in the relationship between EDS and dementia incidence over a 12-year follow-up in community-dwelling older adults. We performed analyses on 6171 subjects (aged ≥65 years) free of dementia and vascular disease at baseline. Participants self-reported EDS at baseline and an expert committee validated both prevalent and incident dementia. We defined cardiovascular burden by a low Cardiovascular Health score, constructed using the American Heart Association metrics, and incident vascular events. To explore the potential role of the cardiovascular burden in the relationship between EDS and dementia, we conducted mediation analyses with inverse odds ratio-weighted estimation, using multivariable-adjusted proportional hazard Cox and logistic regression models. Subjects with EDS had a higher risk of all-cause dementia (hazard ratio HR 1.39, 95% confidence interval CI 1.13-1.69) and dementia with vascular component (DVC) (HR 2.14, 95% CI 1.30-3.51), but not Alzheimer's disease (HR 1.18, 95% CI 0.93-1.51). Cardiovascular burden explained 5% (95% CI 4.1-5.2) and 11% (95% CI 9.7-11.3) of the relationship between EDS and all-cause dementia and DVC, respectively. These findings confirm that EDS may be implicated in the development of dementia and indicate a weaker than expected role of cardiovascular burden in the relationship between EDS and DVC.
Better knowledge of the preclinical phase of Alzheimer's disease would be an important advance to allow earlier treatment of this ominous disease. This prodromal period was investigated in the Paquid ...cohort by analysing change in cognitive performances at five time points over a 9 year period. Neuropsychological measures including global cognitive functioning (Mini-Mental State Examination), visuo-spatial memory (Benton Visual Retention Test), verbal fluency (Isaacs Set Test) and abstract thinking (Wechsler Similarities Test) were assessed in 215 future Alzheimer's disease subjects and 1050 individuals without dementia. The results showed that cognitive performances of the pre-morbid subjects at baseline were already lower than those of individuals without dementia (1.4 points less on the Mini-Mental State Examination; 1.8 points less on the Benton Visual Retention Test; 4 points less on the Isaacs Set Test and 0.8 points less on the Wechsler Similarities Test). For some neuropsychological tests, an acceleration of the decline occurred ∼3 years before the diagnosis and, for each test, the course of decline was modulated by education level. These findings show that abnormally low performances can be evidenced 9 years before the clinical diagnosis of Alzheimer's disease in several domains of cognition beyond memory and that cognitive change over time can be influenced by education.
Abstract The influence of education, occupation, and leisure activities on the passive and active components of reserve capacity remains unclear. We used the voxel-based morphometry (VBM) technique ...in a population-based sample of 331 nondemented people in order to investigate the relationship between these factors and the cerebral volume (a marker of brain reserve). The results showed a positive and significant association between education, occupation, and leisure activities and the cognitive performances on Isaac's set test. Among these factors, only education was significantly associated with a cerebral volume including gray and white matter ( p = 0.01). In voxel-based morphometry analyses, the difference in gray matter volume was located in the temporoparietal lobes and in the orbitofrontal lobes bilaterally (a p -value corrected <0.05 by false discovery rate FDR). Although smaller, the education-related difference in white matter volume appeared in areas connected to the education-related difference in gray matter volume. Education, occupation attainment, and leisure activities were found to contribute differently to reserve capacity. Education could play a role in the constitution of cerebral reserve capacity.
Oral Disease and 3-Year Incidence of Frailty in Mexican Older Adults Castrejón-Pérez, Roberto Carlos; Jiménez-Corona, Aida; Bernabé, Eduardo ...
The journals of gerontology. Series A, Biological sciences and medical sciences,
07/2017, Letnik:
72, Številka:
7
Journal Article
Recenzirano
Odprti dostop
Poor oral health has been associated with some components of frailty. The objective of this study was to identify the association between clinical measures of oral health and the incidence of frailty ...among community-dwelling older adults aged 70 or older in Mexico City.
A 3-year cohort study with a probabilistic representative sample of home-dwelling elders of one district of Mexico City was performed. Baseline and follow-up interview and oral clinical evaluations were carried out by standardized examiners in participants' homes. Dependent variable was incident frailty defined according to the frailty phenotype. Independent variables were the utilization of dental services, the presence of xerostomia, the number of natural teeth, use of removable dental prostheses, presence of severe periodontitis, and presence of root remnants. Sociodemographic, behavioral, and health measures were included as confounders. The association between oral health conditions and incident frailty was modeled using Poisson regression models with robust variance estimators. The models were adjusted for confounders and interactions.
We identified a 14.8% cumulative incidence of frailty. Each additional tooth was associated with a lower probability of developing frailty by 5.0% (risk ratio = 0.90; 95% CI 1.02-1.10). The 3-year risk ratio of developing frailty was 2.13 times higher (95% CI 1.01-4.50) among participants having severe periodontitis.
The number of teeth and the presence of severe periodontitis are associated with the development of frailty after controlling for confounders. Further studies are needed on this topic.
Abstract
Modeling risk-factor trajectories is critical to understanding the natural history of diseases, yet the measurement tools used to assess risk factors often evolve during follow-up in ...cohorts, and such change prevents longitudinal analyses using standard models. We addressed this issue with a latent process model. Trajectories of average intakes of 5 food families (fish, meat, fruits, vegetables, and carbohydrate-rich foods) were described in prodromal dementia during the 10 years prior to diagnosis of cases and compared with those of controls, using a case-control sample nested within the Three-City Study, Bordeaux, France (1999–2012). Food intakes were measured by 2 or 3 different subquestionnaires across 5 repeated food frequency questionnaires. The sample comprised 205 incident cases and 410 controls matched for age, sex, education, and number of repeated food frequency questionnaires. Intakes of fish, fruits, and vegetables decreased at the approach of diagnosis among cases, suggesting reverse causation. This study demonstrated that the latent process model approach constitutes a powerful framework for modeling risk-factor trajectories, even when measurement tools change sequentially over time. Coupled with a case-control approach to contrast trajectories in prodromal disease versus healthy status, it can help us to understand the dynamic, causal relationships between risk factors and diseases.
The aim of this work was to determine the predictive value of 2 indicators of psychosocial isolation (living alone and feelings of loneliness) in elderly people.
Twenty-two-year follow-up cohort ...study of 3,620 community-dwelling elderly people enrolled in the PAQUID study, a French prospective population-based study. Participants completed a battery of tests including the Centre for Epidemiological Studies Depression scale and a question regarding living conditions (living alone or living with another person). Feelings of loneliness were measured using the Item 14 ("I felt lonely") of the French version of the Centre for Epidemiological Studies Depression scale. Mortality rate was measured over a 22-year follow-up period after the baseline assessment visit. The risk of death was estimated using Cox proportional hazards models, adjusted for age, sex, and educational level.
At baseline, 1,535 participants (42.4%) were living alone, and a total of 498 persons (13.8%) reported frequent feelings of loneliness (FoL). The participants reporting FoL were more frequently women (82.7%), and the mean (SD) age was 76.5 (7.1) years. At the end of the follow-up, 3,116 deaths (86.6%) occurred. Living alone and FoL were both independent predictors of death after 22 years of follow-up (hazard ratio, 1.14; 95% confidence of interval, 1.05-1.23; p = .001) and (hazard ratio, 1.20; 95% confidence of interval, 1.08-1.33; p = .001), respectively. No significant interaction was found between feelings of loneliness and living alone, suggesting that a joint exposure has only an additive effect (β = 0.08; relative risk = (0.85; 1.40); p = .48). The associations of both measures persisted after adjusting for health status. Adjusting for depression attenuated the predictive value of FoL.
Living alone and FoL were independently associated with higher risk of mortality. These factors may be useful as readily available psychosocial measures to identify vulnerability in community-dwelling older adults.
A better knowledge of long-term trajectories of cognitive decline is a central feature of the study of the process leading to Alzheimer's dementia. Several factors may mitigate such decline, among ...which is education, a major risk factor for Alzheimer's disease. The aim of our work was to compare the pattern and duration of clinical trajectories before Alzheimer's dementia in individuals with low and high education within the PAQUID cohort involving 20 years of follow-up. The sample comprises 442 participants with incident Alzheimer's disease (27.2% were male)--171 with low education (mean age=86.2 years; standard deviation=5.3 years) and 271 with higher education (mean age=86.5; standard deviation=5.4)--and 442 control subjects matched according to age, sex and education. At each visit and up to the 20-year follow-up visit, several cognitive and clinical measures were collected and incident cases of Alzheimer's disease clinically diagnosed. The evolution of clinical measures in pre-demented subjects and matched controls was analysed with a semi-parametric extension of the mixed effects linear model. The results show that the first signs of cognitive decline occurred 15 to 16 years before achieving dementia threshold in higher-educated subjects whereas signs occurred at 7 years before dementia in low-educated subjects. There seemed to be two successive periods of decline in higher-educated subjects. Decline started ∼15 to 16 years before dementia with subtle impairment restricted to some cognitive tests and with no impact during the first 7 to 8 years on global cognition, cognitive complaints, or activities of daily living scales. Then, ∼7 years before dementia, global cognitive abilities begin to deteriorate, along with difficulties dealing with complex activities of daily living, the increase in self-perceived difficulties and depressive symptoms. By contrast, lower-educated subjects presented a single period of decline lasting ∼7 years, characterized by decline concomitantly affecting specific and more global cognitive function along with alteration in functional abilities. This study demonstrates how early cognitive symptoms may emerge preceding Alzheimer's dementia particularly in higher-educated individuals, for whom decline occurred up to 16 years before dementia. It also demonstrates the protective role of education in the clinical trajectory preceding Alzheimer's dementia. We suggest that the initial decline in cognition occurs at the onset of comparable Alzheimer's disease pathology in both groups, and is associated with immediate decline to dementia in the lower education group. In contrast, higher education protects against further cognitive decline for ∼7 years until pathology becomes more severe.
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