. Meeting two or more criteria for metabolic syndrome was also highly correlated with the development of overall dementia, and the adjusted HR was significantly higher in VaD than in AD (HR 1.37 vs 1.14). Background Common infections have been associated with dementia risk; however, evidence is scarce. The site is secure. How Can Hearing Loss Cause Dementia? - PMC - National Center for The baseline clinical and biochemical characteristics of the subjects are summarized in Table 1. During 29,089,302 person-years of follow-up, a total of 363,932 subjects (6.4%) developed incident dementia. Sternberg SA, Wershof Schwartz A, Karunananthan S, Bergman H, Mark Clarfield A. The National Health Insurance System (NHIS) of Korea consists of the two major programs: National Health Insurance (NHI), which covers 97% of the population, and Medical Aid (MA), which covers the remaining 3% of the population (with low income). With respect to the impact of metabolic status on dementia, our study revealed that having two or more metabolic abnormalities was associated with development of both AD and VaD. analyzed and interpreted the data. Subgroup analysis of risk of dementia associated with frailty. . The sample consisted of 2,619 participants aged 65 and older without dementia at baseline followed from 1994 to 2010. Our study results are in line with previous study results showing significant risk reduction of AD in old subjects who are obese. Quality of Life in children and young people with Congenital Adrenal Hyperplasia UK nationwide multicentre assessment, The Impact of Gender Affirming Hormone Therapy on Physical Performance, The Journal of Clinical Endocrinology & Metabolism, About The Journal of Clinical Endocrinology & Metabolism, Receive exclusive offers and updates from Oxford Academic. Weight loss was defined as losing more than 7.5% of body weight since the previous ACT visit. Clinical and neuropsychological assessment of Alzheimers disease, The Halstead-Reitan neuropsychological test battery, WMS-R: Weschler Memory Scale-Revised manual, Diagnostic and Statistical Manual of Mental Disorders. had the main responsibility for statistical analysis, and J.Y.L., K.H., G.K., E.H., and Y.H.L. In contrast, with regard to the development of hypertension, type 2 DM, and chronic kidney disease (CKD), MHO subjects were at 1.4- to 1.6-fold higher risk than their nonobese counterparts (1719). All statistical analyses were performed in SAS version 9.2 (SAS Institute, Cary, NC) and R programming version 3.1.0 (The R Foundation for Statistical Computing, Vienna, Austria, http://www.R-project.org). Briefly, study participants, aged 65 years and older, were randomly sampled from Seattle-area members of Group Health, an integrated health care system in Washington state. Previous studies investigating the association between obesity and the development of dementia reported that midlife obesity was associated with a 1.7- to 2.0-fold higher risk of incident dementia (12, 38). . the contents by NLM or the National Institutes of Health. To analyze the association between frailty and risk of dementia, we estimated hazard ratios (HR) using Cox proportional hazards regression models with participant age as the time scale (27) and the event time taken to be the age at dementia onset. 7Psychosocial and Community Health, University of Washington, Seattle. Incident dementia was defined using a combination of interview- and performance-based methods. Medical care costs for people with dementia are increasing and are substantially greater than those for cancer, heart disease, or other diseases (5). The National Health Insurance System, Republic of Korea. Fasting plasma glucose 100 mg/dL or on antidiabetic medication. 4Division of General Internal Medicine, and. Buchman AS, Schneider JA, Leurgans S, Bennett DA. Further adjusted for tobacco and alcohol use, exercise, socioeconomic status, LDL-C. Avila-Funes and colleagues (11) also did not find an association between frailty and risk of dementia in participants with intact cognition at baseline in a large French sample followed for 4 years. Subjects of current smoker, heavy drinker, and not physically active. 1School of Pharmacy, University of Washington, Seattle. Survival analysis was used to determine if ACTIVE treatment affected the rate of incident dementia during 5 years of follow-up. Thus, we had expected the increased risk to be evident in participants with lower cognitive scores rather than the higher cognitive functioning group because these individuals were closer to the threshold for cognitive impairment that triggered the evaluation for dementia. We examined three outcomes in these analyses: all-cause dementia, possible or probable AD, and non-AD dementia. FOIA Participants whose CASI scores were less than 86 underwent a standardized dementia diagnostic evaluation, including a physical and neurological examination by a study neurologist, geriatrician, or internist and a 1-hour battery of neuropsychological testing. Frailty was defined as having at least 3 of the following criteria: weakness (grip strength), slowness (walking speed), weight loss, low physical activity, and self-reported exhaustion. The neuropsychological testing included the clock drawing (15), verbal fluency (16), Mattis Dementia Rating Scale (17), Boston naming (16), verbal paired associations and recall, logical memory and recall (17), Word List Memory (16), Constructional Praxis and recall (16), Trails A and B (18), and Information and Comprehension subtest items (19). Gait speed, body composition, and dementia. There is a possibility of coding errors or underestimation or overestimation. and Y.H.L. An additional 811 participants were enrolled between 2000 and 2002, and in 2004 the study began continuous enrollment (n = 1,023 as of September 30, 2010), to replace those who die or drop out from a total of 4,415 study participants. This outcome includes several types of dementia not meeting the possible or probable AD definition. Dementia - Symptoms and causes - Mayo Clinic The mean age at baseline was 76.8 (standard deviation [SD] 5.9) years, approximately 60% were female, and more than 60% had at least some college education. Inclusion in an NLM database does not imply endorsement of, or agreement with, Multi-domain amnestic and single domain non-amnestic MCI subtypes were significantly associated with incident dementia for both diagnostic approaches (all p . This effect was more prominent in VaD, with a 41% greater risk in MUNO subjects compared with MHNO subjects and a 31% greater risk in MUO subjects compared with MHO subjects. is the guarantor of this work and as such had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Because POPs are usually lipophilic and are distributed in adipose tissue, serum concentrations increase after weight loss, with redistribution to tissues such as brain (59). Kelley AS, McGarry K, Gorges R, Skinner JS. Risk factors for incident dementia in England and Wales: The Medical (C) VaD. In the model adjusted for age, sex, education, and race, the hazard ratio for frailty was 1.78 (95% confidence interval [CI] 1.322.40). drafted the manuscript, and all authors reviewed and commented on drafts for important intellectual content. Accounting for interval censoring of dementia onset by using the midpoint of the interval in which onset occurred is robust to bias in time-to-event analyses (22,23). In the current study, we used NHIS data, a well-established cohort representing the entire Korean population, which is >50 million. Abstract. Table 2 provides baseline characteristics of the 2,619 eligible ACT participants according to baseline frailty status. When both MCI definitions were included in the same model, only the Jak/Bondi definition remained statistically significantly associated with incident dementia (HR=2.47; p-value=.008). An unexpected finding of this study was that the association between frailty and dementia varied according to baseline cognitive scores. Neuropsychological Criteria for Mild Cognitive Impairment and Dementia Methods It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. HRs for Developing Dementia According to Obesity Status and Metabolic Syndrome Criteria. Searching for an Operational Definition of Frailty: a Delphi Method Based Consensus Statement. Compared with subjects who are not obese, subjects who are obese had a lower risk of overall dementia (HR 0.90; 95% CI, 0.89 to 0.91) and AD (HR 0.88; 95% CI, 0.87 to 0.89), but obesity had no beneficial impact on VaD (HR 1.01; 95% CI, 0.99 to 1.03). Our study has several limitations. Participants with new-onset dementia underwent at least one annual follow-up examination for verification of dementia status and subtype. Cardiovascular health was defined as low (score 0-4/0-5), intermediate (5-7/6-9), or high (8-12/10-14). visit 5 through to the end of visit 6 (December 31, 2017). Values are presented as mean (SD) for continuous variables and n (%) for categorical variables. The incidence rates (number of events per 1000 person-years) and HRs of overall dementia, AD, and VaD according to metabolic health and obesity status are demonstrated in Table 2. Among the four groups, MHO subjects showed the lowest incidences of overall dementia and AD but were no different in the development of VaD. In addition, recent evidence suggests that both VaD and AD are closely related to cardiovascular risk factors such as hypertension, diabetes mellitus (DM), hyperlipidemia, and cigarette smoking (811). Walking speed was assessed by having participants walk a 10-foot distance at their usual speed using assistive devices if needed. Grip strength was assessed using a handheld dynamometer and measured to the nearest 0.1kg. Prevalence, attributes, and outcomes of fitness and frailty in community-dwelling older adults: report from the Canadian study of health and aging, The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, Weight loss of 7.5% of body weight since prior study visit, Self-reported positive response to one of two questions from the CESD scale: I felt that everything I did was an effort; I could not get going.. When both MCI definitions were included in the same model, only the Jak/Bondi definition remained statistically significantly associated with incident dementia (HR = 2.47; p-value = .008). However, the risk of dementia was higher in the MUO group, whereas it was lower in the MUNO group, suggesting that being underweight contributes significantly to the development of dementia. Third, because the mean BMI of the MHO group was 27.0 kg/m2, the study results may not be generalizable to a more severely obese group. Buchman AS, Schneider JA, Wilson RS, Bienias JL, Bennett DA. Avila-Funes JA, Amieva H, Barberger-Gateau P, et al. In comparing the results of Model 3 with Model 2, further adjustment for baseline cognitive score attenuated the strength of the relationship between frailty and all dementia outcomes. The assumption was satisfied for all models. All authors approved the final manuscript and the decision to submit for publication. HDL-C <40 mg/dL in men or <50 mg/dL in women. Systolic BP 130 mm Hg or diastolic BP 85 mm Hg or on antihypertensive medication. Among subjects 60 years old, 363,932 (6.4%) developed dementia during a median follow-up of 65 months (interquartile range 51 to 74 months). K.H. Therefore, we investigated the impact of the MHO phenotype on incident dementia according to body mass index (BMI) and metabolic health status by using a nationwide population-based cohort study. The MHO phenotype in late life demonstrated lower risk of overall dementia and AD but not VaD. Incident myocardial infarction (MI) has no association with a decline in cognition, memory, and executive function immediately following the event. Consistent with the main results, the MHO group showed the lowest incidence of overall dementia and AD; incident VaD was not affected, regardless of the presence of modifiable risk factors (Table 3). Y.H.L. Ye BS, Jang EY, Kim SY, Kim EJ, Park SA, Lee Y, Hong CH, Choi SH, Yoon B, Yoon SJ, Na HR, Lee JH, Jeong JH, Kim HJ, Na DL, Seo SW. Jang H, Kim JH, Choi SH, Lee Y, Hong CH, Jeong JH, Han HJ, Moon SY, Park KW, Han SH, Park KH, Kim HJ, Na DL, Seo SW. Oreopoulos A, Padwal R, Kalantar-Zadeh K, Fonarow GC, Norris CM, McAlister FA. Because neither dementia subtype nor herpes subtype modified the association, the small but significant decrease in dementia incidence with antiherpetic adminstration may reflect confounding and misclassification. Increased dementia incidence in the metabolically unhealthy groups was more prominent in VaD, and risk reduction in obese groups was evident in AD. Frailty and Incident Dementia - PMC - National Center for Biotechnology If diagnoses of both AD and VaD were recorded at the first visit, we used the diagnosis of the second visit. Results from the Three-City Study. Baseline global cognitive functioning was an important confounder and reduced the magnitude of associations between frailty and the three dementia outcomes. Second, plasma IGF-1 levels decline in the underweight group (49). All Koreans must be registered in one of these two systems. IN the care of older adults, frailty is a term often used to describe a general health status characterized by increased vulnerability to stressors because of impairment in physiological reserve. Dementia is a syndrome that can be caused by a number of diseases which over time destroy nerve cells and damage the brain, typically leading to deterioration in cognitive function (i.e. The risk for dementia among subjects who are obese with normal metabolic profiles, or called metabolically healthy obese (MHO), remains uninvestigated. Age-adjusted incidence rates of these outcomes were considerably higher for those who were frail at baseline (Figure 2). Mechanisms underlying these associations remain to be elucidated. In the model adjusted for age, sex, education, and race, frailty was associated with an increased risk of dementia (Table 3; Model 1: adjusted HR 1.78, 95% confidence interval [CI] 1.322.40). Since 2006, the database of MA beneficiaries has been integrated into the NHIS database (20, 21). Furthermore, all criteria for metabolic syndrome (high BP, hyperglycemia, high TG, and low HDL-C) were associated with a higher risk of incident dementia. Amnestic mild cognitive impairment and incident dementia and - PubMed First, because being underweight is associated with vitamin and mineral deficiencies and because undetected subtle dementia may cause body weight loss, sensitivity analyses were conducted after exclusion of subjects with BMI <18.5 kg/m2. Diagnoses were assigned at consensus diagnostic conferences using the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for dementia (20) and criteria of the National Institute of Neurological and Communicative Disorders and Stroke and Alzheimers Disease and Related Disorders Association for AD (21). Similar patterns were noted for subjects aged 50 to 60 years (n = 6,627,375), although the protective effect of the MHO phenotype on overall dementia was smaller than that in subjects aged >60 years (Tables 6 and 7). The purpose of this study is to estimate the association between frailty and incident dementia in China, and to explore different effects of frailty established by three definitions of frailty on dementia incidence. RESEARCH DESIGN AND METHODS Using a health insurance claims database and the results of biennial health examinations in South Korea, we selected 8,400,950 subjects aged 40 years who underwent health examinations in 2009-2010. The crude incidence rate of overall dementia was 5.7% (99,538/1,738,074) in the MHNO group, 8.1% (150,341/1,852,845) in the MUNO group, 4.3% (27,675/644,447) in the MHO group, and 6.0% (86,378/1,434,122) in the MUO group. Experiencing memory loss, poor judgment, and confusion Difficulty speaking, understanding and expressing thoughts, or reading and writing Wandering and getting lost in a familiar neighborhood Trouble handling money responsibly and paying bills Repeating questions Using unusual words to refer to familiar objects Incident dementia was identified through linked data to primary care or hospital admission records and death registries. Additional prospective are needed to determine metabolic health and obesity status as predisposing factors for dementia. On average, the exact time of first possible diagnosis could be assumed at the midway point between the follow-up visit, when . 10.1371/journal.pone.0024817 Abstract Background: We know little about incidence and predictors of dementia in China, where the prevalence is increasing and the patterns of risk factors are different. Whitmer RA, Gunderson EP, Barrett-Connor E, Quesenberry CP Jr, Yaffe K. Fitzpatrick AL, Kuller LH, Lopez OL, Diehr P, OMeara ES, Longstreth WT Jr, Luchsinger JA. To investigate the risk of incident dementia according to fasting glucose levels and presence of comorbidities. Part I. Incident definition, an individual occurrence or event. In our study, hyperglycemia increased the risk of overall dementia and AD 1.2-fold and raised the risk of VaD 1.3-fold. Participants were required to have at least two biennial visits after the ACT enrollment visit for study inclusion. To identify a subject as metabolically healthy, we used the Adult Treatment Panel III (ATP-III) definition (26). Association of change in cardiovascular risk factors with incident dementia During the 17,075 person-years of follow-up (mean 6.5, SD 3.9 years), 521 cases of dementia were diagnosed, of which 448 were cases of probable or possible AD and 73 were cases of non-AD dementia. Participants were asked to use their dominant hand to grip the handle with maximal effort for three attempts; the average of these three attempts was used. When these investigators used a categorical measure of frailty, similar to the frailty definition we used, frailty was associated with a twofold increase risk for AD after adjusting for age, sex, and education. There is no standard definition for frailty , but generally accepted components include muscle weakness, fatigue, . However, in our large-scale analyses, both high TG and low HDL-C were associated with a 6% to 16% higher risk of dementia. The Rotterdam Study, Pigment epithelium-derived factor (PEDF), a novel adipokine contributes to gestational diabetes mellitus (GDM). This is the first study to our knowledge that has examined the association between frailty and incident dementia stratified by baseline cognitive scores. 50 This finding was replicated in a smaller cohort of 52 PD patients in which OH increased the odds of cognitive decline 5.5-fold over 3 years, after adjustment . Our findings are consistent with two longitudinal studies (5,11) but not with the other (10). Algorithm for classification of incident dementia. Dementia, Alzheimers disease, Frailty, Epidemiology. Definition and Prevalence of Frailty Components (n = 2,619). Incident Definition & Meaning | Dictionary.com Address correspondence to Shelly Gray, PharmD, MS, School of Pharmacy, University of Washington, Box 357630, Seattle, WA 98195-7630. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. The association between frailty and incidence of dementia in Beijing Risk Factors for Incident Dementia Among Older Cubans Frailty status and altered glucose-insulin dynamics. Lee YH, Han K, Ko SH, Ko KS, Lee KU; Cheol Seong S, Kim YY, Khang YH, Heon Park J, Kang HJ, Lee H, Do CH, Song JS, Hyon Bang J, Ha S, Lee EJ, Ae Shin S. Song SO, Jung CH, Song YD, Park CY, Kwon HS, Cha BS, Park JY, Lee KU, Ko KS, Lee BW. We found that frailty was associated with non-AD dementia. Physical frailty is associated with incident mild cognitive impairment in community-based older persons. Additional studies in other populations are warranted to elucidate current results and may predict individuals most at risk for developing dementia. The Frailty Operative Definition-Consensus Conference Project, Frailty in older adults: evidence for a phenotype, Frailty: emergence and consequences in women aged 65 and older in the Womens Health Initiative Observational Study. (A) Overall dementia. Comparison of the predictive accuracy of multiple definitions of Buchman AS, Boyle PA, Wilson RS, Tang Y, Bennett DA. Regarding hyperlipidemia and dementia, the published findings are inconsistent (3437). Conclusions The effect of stroke on dementia incidence in the population . Association of Apathy With Risk of Incident Dementia: A - PubMed Model 1 was adjusted for age at baseline, sex, education, and race. Plots use different y-axis scales. Notes: CI = confidence interval; HR = hazard ratio. Definition of incident dementia. Author Contributions:J.Y.L., K.H., G.K., E.H., H.C., and Y.H.L. Federal government websites often end in .gov or .mil. Subjects of noncurrent smoker, not heavy drinker, and physically active. Aging, family history, apolipoprotein E4 phenotype, and lower educational level are well-known risk factors for both AD and VaD (6, 7). The five MetS components measured before 70 years of age, considered on a continuous scale, showed the risk of dementia to increase with each additional component. 4-2016-0770), and informed consent from study subjects was waived because of the retrospective cohort nature of the study. Frailty and Incident Dementia | Request PDF - ResearchGate Future research in other samples is needed to explore the association with frailty and dementia subtypes. Notes: CASI = Cognitive Abilities Screening Instrument; CESD scale = Center for Epidemiological Studies Depression scale; SD = standard deviation. The impact on VaD was less than expected, probably because we defined hyperglycemia as including both prediabetes and diabetes (either fasting plasma glucose 100 mg/dL or on antidiabetic treatment), whereas previous studies were conducted only in patients with diabetes. Early identification and timely intervention of modifiable risk factors is of great clinical importance in slowing or preventing dementia onset (Livingston et al., 2017).While meta-analyses show that depression is associated with a two-fold increase in risk of dementia (Diniz et al., 2013; Ownby et al., 2006), several key questions . Methods: Data were from 1,846 participants in the Cuban cohort of the 10/66 Dementia Research Group. This database contains demographic information (eg, age, sex, income level), claim information [diagnosis defined by International Classification of Diseases (ICD) codes and details of prescriptions], and health checkup information (results of basic laboratory tests and questionnaires about past medical history, current medications, and lifestyle). performance or only cognitive decline. ACTIVE Cognitive Training and Rates of Incident Dementia Kang YM, Jung CH, Jang JE, Hwang JY, Kim EH, Park JY, Kim HK, Lee WJ. Perhaps those in the lower quartile of cognitive scores, even though considered within the normal range of cognition for this study, may include participants who had mild cognitive impairment or impending dementia that may overshadow any association that frailty might have with incident dementia. Covariates came from self-report and study measures. Descriptive analyses were stratified by baseline frailty status and presented as counts and percentages for categorical variables. We analyzed a nationwide population over 29,089,304 person-years of follow-up. Abellan van Kan G, Rolland Y, Gillette-Guyonnet S, et al. Identifying frailty in older adults is important as it may help clinicians recognize those who are at increased risk for several adverse health outcomes including death, hospitalization, and disability (7). Alzheimer's disease first affects the part of the brain associated with learning, so early symptoms often include changes in memory, thinking and reasoning skills. Frailty was defined as having at least 3 of the following criteria: weakness (grip strength), slowness (walking speed), weight loss, low physical activity, and self-reported exhaustion. In addition, two studies from the meta-analysis reported an increased risk of dementia with 3 months of use of bladder antimuscarinics (adjusted odds ratios ranged from . In addition, for the outcome of AD, individuals were censored at the time of non-AD dementia diagnosis. Alzheimer's disease is the most common type of dementia. Risk of incident all-cause dementia by baseline hearing loss after adjustment for age, sex, race, education, diabetes mellitus, smoking, and hypertension. Fourth, persistent organic pollutants (POPs) such as polychlorinated biphenyls and polychlorinated dibenzofurans have been reported to cause various toxic effects, especially in neurocognitive function (55, 56). ACT = Adult Changes in Thought study. We used a cutoff value of 86 on the CASI to identify individuals for dementia evaluation because this score has a sensitivity and specificity of 96.5% and 92.0%, respectively (14). The excess risk of incident dementia diminishes with time after stroke and may be higher in those without an APOE 4 allele.
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