Little research has investigated long-term associations of childhood reading with cognitive ageing. The aim of this study was to test longitudinal associations between childhood reading problems and ...cognitive function from mid-adulthood (age 43) to early old age (age 69), and whether associations were mediated by education.
Data were from the MRC National Survey of Health and Development, a prospective population-based birth cohort. Reading problems were measured at age 11 using a reading test. Verbal memory and processing speed were measured at ages 43, 53, 60-64 and 69 and Addenbrooke's Cognitive Examination (ACE) was administered at age 69. Linear mixed models and path analyses were used to test: (1) associations between reading problems and verbal memory and processing speed trajectories; (2) associations between reading problems and ACE-III scores; (3) whether associations were mediated by education.
Reading problems were associated with poorer verbal memory at intercept but not rate of decline (N=1726), and were not associated with processing speed intercept or decline (N=1730). There were higher rates of scores below ACE-III clinical thresholds (<82 and <88) in people with reading problems compared with those without. Reading problems were associated with poorer total ACE-III scores and all domain scores at age 69 (N=1699). Associations were partly mediated by education.
Reading problems in childhood were associated with poorer cognitive function in early old age, and associations were partly mediated by education.
There is an association between affective symptoms and cognition. However, the direction of this association remains unclear. This study aimed to test bidirectional relationships between affective ...symptoms and cognition from middle to late adulthood.
Data were available from the MRC National Survey of Health and Development (NSHD), a prospective birth cohort of 5362 people born in 1946. Affective symptoms and cognition were measured at ages 53, 60-64, and 69. Latent scores of affective symptoms were derived and cross-lagged models were fitted for affective symptoms with verbal memory and processing speed.
Results revealed an inverse cross-sectional association between affective symptoms and verbal memory (β=−0.18, SE=0.04, p<.001) and processing speed (β=−0.13, SE=0.06, p=.05) at age 53, but not at ages 60-64 or 69. Affective symptoms at age 53 predicted lower verbal memory at age 60-64 (β=−0.58, SE=0.27, p=.03), and affective symptoms at age 60-64 predicted lower verbal memory (β=−0.64, SE=0.29, p=.03) and processing speed (β=−1.27, SE=0.41, p=.002) at age 69. Verbal memory and processing speed did not predict subsequent affective symptoms.
Affective symptoms predict poorer verbal memory and processing speed over a period of 16 years, but not vice versa.
Affective symptoms are associated with cognition in mid-life and later life. However, the role of cardiometabolic risk in this association has not been previously examined.
To investigate how ...cardiometabolic risk contributes to associations between affective symptoms and mid-life cognition.
Data were used from the National Child Development Study (NCDS), a sample of people born in Britain during one week in 1958. Measures of immediate and delayed memory, verbal fluency and information processing speed and accuracy were available at age 50. Affective symptoms were assessed at ages 23, 33 and 42 years and a measure of accumulation was derived. A cardiometabolic risk score was calculated from nine cardiometabolic biomarkers at age 44. Path models were run to test these associations, adjusting for sex, education, socioeconomic position and affective symptoms at age 50.
After accounting for missing data using multiple imputation, path models indicated significant indirect associations between affective symptoms and mid-life immediate memory (β = -0.002, s.e. = 0.001, P = 0.009), delayed memory (β = -0.002, s.e. = 0.001, P = 0.02) and verbal fluency (β = -0.002, s.e. = 0.001, P = 0.045) through cardiometabolic risk.
These findings suggest that cardiometabolic risk may play an important role in the association between affective symptoms and cognitive function (memory and verbal fluency). Results contribute to understanding of biological mechanisms underlying associations between affective symptoms and cognitive ageing, which can have implications for early detection of, and intervention for, those at risk of poorer cognitive outcomes.
IntroductionHarm from catheter-associated urinary tract infections is a common, potentially avoidable, healthcare complication. Variation in catheter prevalence may exist and provide opportunity for ...reducing harm, yet to date is poorly understood. This study aimed to determine variation in the prevalence of urinary catheters between patient groups, settings, specialities and over time.MethodsA prospective study (July 2012 to April 2016) of National Health Service (NHS) patients surveyed by healthcare professionals, following a standardised protocol to determine the presence of a urinary catheter and duration of use, on 1 day per month using the NHS Safety Thermometer.Results1314 organisations (253 NHS trusts) and 9 266 284 patients were included. Overall, 12.9% of patients were catheterised, but utilisation varied. There was higher utilisation of catheters in males (15.7% vs 10.7% p<0.001) and younger people (18–70 year 14.0% vs >70 year 12.8% p<0.001), utilisation was highest in hospital settings (18.6% p<0.001), particularly in critical care (76.6% p<0.001). Most catheters had been in situ <28 days (72.9% p<0.001). No clinically significant changes were seen over time in any setting or specialty.ConclusionCatheter prevalence in patients receiving NHS-funded care varies according to gender, age, setting and specialty, being most prevalent in males, younger people, hospitals and critical care. Utilisation has changed only marginally over 46 months, and further guidance is indicated to provide clarity for clinicians on the insertion and removal of catheters to supplement the existing guidance on care.
Psychological therapies can be effective in reducing symptoms of depression and anxiety in people living with dementia (PLWD). However, factors associated with better therapy outcomes in PLWD are ...currently unknown.
To investigate whether dementia-specific and non-dementia-specific factors are associated with therapy outcomes in PLWD.
National linked healthcare records were used to identify 1522 PLWD who attended psychological therapy services across England. Associations between various factors and therapy outcomes were explored.
People with frontotemporal dementia were more likely to experience reliable deterioration in depression/anxiety symptoms compared with people with vascular dementia (odds ratio 2.98, 95% CI 1.08-8.22;
= 0.03) or Alzheimer's disease (odds ratio 2.95, 95% CI 1.15-7.55;
= 0.03). Greater depression severity (reliable recovery: odds ratio 0.95, 95% CI 0.92-0.98,
< 0.001; reliable deterioration: odds ratio 1.73, 95% CI 1.04-2.90,
= 0.04), lower work and social functioning (recovery: odds ratio 0.98, 95% CI 0.96-0.99,
= 0.002), psychotropic medication use (recovery: odds ratio 0.67, 95% CI 0.51-0.90,
= 0.01), being of working age (recovery: odds ratio 2.03, 95% CI 1.10-3.73,
= 0.02) and fewer therapy sessions (recovery: odds ratio 1.12, 95% CI 1.09-1.16,
< 0.001) were associated with worse therapy outcomes in PLWD.
Dementia type was generally not associated with outcomes, whereas clinical factors were consistent with those identified for the general population. Additional support and adaptations may be required to improve therapy outcomes in PLWD, particularly in those who are younger and have more severe depression.
•Recurrent lifetime affective problems predict diminished late-life cognitive state.•Those with affective problems only once do not show risk of lower cognitive state.•Recurrence, rather than timing, ...of problems is more predictive.•These associations remain even when controlling for prior childhood cognition.•The risk of lower cognitive state is already manifest in early old age (age 69).
Affective problems increase the risk of dementia and cognitive impairment, yet the life course dimension of this association is not clearly understood. We aimed to investigate how affective problems across the life course relate to later-life cognitive state.
Data from 1269 participants from the Medical Research Council National Survey of Health and Development (NSHD, the British 1946 birth cohort) were used. Prospectively-assessed measures of affective symptoms spanning ages 13–69 and categorised into case-level thresholds. Outcomes consisted of a comprehensive measure of cognitive state (Addenbrooke's Cognitive Examination (ACE-III)), verbal memory, and letter search speed and accuracy at age 69.
Complementary life course models demonstrated that having 2 or more case-level problems across the life course was most strongly associated with poorer cognitive outcomes, before and after adjusting for sex, childhood cognition, childhood and midlife occupational position and education.
A disproportionate loss to follow-up of those who had lower childhood cognitive scores may have led to underestimation of the strength of associations.
Using a population-based prospective study we provide evidence that recurrent lifetime affective problems predicts poorer later-life cognitive state, and this risk can be already manifest in early old age (age 69). Our findings raise the possibility that effective management to minimise affective problems reoccurring across the life course may reduce the associated risk of cognitive impairment and decline.
Background: Little is known about what factors can modify the relationship between affective symptoms and cognitive function across the life course.
Aim: To investigate a number of factors that can ...contribute to resilience in cognitive function in relation to affective symptoms, using data from the National Child Development Study.
Subjects and methods: Adult affective symptoms were measured using the Malaise Inventory Scale (ages 23, 33, 42 and 50). Measures of immediate and delayed memory, verbal fluency and information processing accuracy (age 50) were used to derive measures of resilience in cognitive function-better than predicted cognition, when accounting for experiences of affective symptoms. Factors contributing to resilience in cognitive function were informed by a literature review and included sex, childhood cognitive ability, education, household socio-economic position (SEP), midlife SEP, and APOE genotype. Linear regression and structural equation modelling approaches were used for analyses.
Results: Higher childhood cognitive ability, educational level, midlife SEP and female sex contributed to better than predicted cognitive function in relation to affective symptoms (i.e. resilience), with particularly consistent effects for memory. No effects on resilience were revealed for APOE genotype.
Conclusion: Understanding factors contributing to resilience in cognitive function in those with affective symptoms can inform interventions to promote healthy cognitive ageing for those at risk.
BackgroundDementia incidence is increasing across the globe and currently there are no disease-modifying pharmaceutical treatments. The Lancet Commission on dementia identified 12 modifiable risk ...factors which explain 40% of dementia incidence. However, whether these associations are causal in nature is unclear.ObjectiveTo examine the modifiable risk factors for dementia as identified in the Lancet Commission review using Mendelian randomisation (MR) to establish if, based on genetic evidence, these associations with different dementia subtypes are causal in nature.MethodsPublicly available genome-wide association study data were used for 10 risk factors and Alzheimer’s disease (AD), frontotemporal dementia and dementia with Lewy bodies. Two-sample MR using the inverse varianceweighted method was conducted to test for causal relationships. Weighted median MR and MR-Egger were used to test for pleiotropic effects.ResultsGenetic proxied risk for higher levels of smoking (OR: 0.80 (95% CI: 0.69; 0.92), p=0.002), obesity (OR: 0.87 (95% CI: 0.82; 0.92), p<0.001) and blood pressure (OR: 0.90 (95% CI: 0.82; 0.99), p=0.035) appeared to be protective against the risk of AD. Post hoc analyses indicated these associations had pleiotropic effects with the risk of coronary artery disease. Genetic proxied risk of educational attainment was found to be inconsistently associated with the risk of AD.Conclusions and implicationsPost hoc analysis indicated that the apparent protective effects of smoking, obesity and blood pressure were a result of survivor bias. The findings from this study did not support those presented by the Lancet Commission. Evidence from causal inference studies should be considered alongside evidence from epidemiological studies and incorporated into reviews of the literature.
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