International Journal of Geriatric Psychiatry最新文献

Objective

To investigate the dose-response relationship between handgrip strength and incidence of Alzheimer's disease (AD) in middle-aged and older adults.

Design

Longitudinal study.

Patients and Methods

A longitudinal study was conducted in people over 50 years old in 27 European countries and Israel. Data were collected from waves 1, 2, 4, 5, 6, 7 and 8 of the Survey of Health, Ageing and Retirement in Europe (SHARE) between February 2004 and January 2021. Handgrip strength was measured with a hand dynamometer. AD was self-reported based on previous diagnosis. Dose-response associations were assessed by restricted cubic splines.

Results

A total of 85,979 (55.8% female) participants were followed for a median of 9.3 years. Over this time, 3324 (3.9%) developed AD. In the adjusted model, for participants < 65 years, those in the middle third of handgrip strength showed a lower risk of AD compared to the lower third (HR = 0.63, 95% CI: 0.47–0.84), as well as participants in the upper third (HR = 0.63, 95% CI: 0.47–0.85). The spline model determined that the minimum and optimal doses of handgrip strength for a significant reduction in the risk of AD for those aged < 65 years were 54 kg (HR = 0.99; 95% CI: 0.08–0.99) and 56 kg (HR = 0.27; 95% CI: 0.08–0.91), respectively. Among those aged ≥ 65 years, the minimum and optimal doses were 31 kg (HR = 0.69; 95% CI: 0.48–0.99) and 49 kg (HR = 0.57; 95% CI: 0.43–0.76), respectively.

Conclusion

Higher levels of handgrip strength showed a lower risk of developing AD, among adults aged 50 years and over. However, the dose-response relationship is limited to specific ranges according to age group. We identified a range between 54 and 56 kg years and a range between 31 and 49 kg as suitable to prevent AD in adults aged 50–64 and ≥ 65 years, respectively. Routine assessment of hand grip strength can help healthcare professionals identify people at increased risk of AD. Strength-based interventions could provide a practical strategy to support cognitive health and reduce the risk of dementia in clinical practice.

Introduction

Plasma phosphorylated tau (p-tau) levels, such as p-tau181, are elevated in Alzheimer's disease compared to cognitively unimpaired individuals. They represent potential candidate blood biomarkers for use in memory services where CSF examinations are not available. However, the effect of age on plasma p-tau levels remains undetermined. Limited studies have investigated the association between age and plasma p-tau thus far, and fewer still have differentiated levels by brain amyloid pathology. Characterising these associations and determining if this is influenced by sociodemographic factors or medical comorbidities is important for establishing blood biomarker reference ranges.

Methods

Using ADNI data, we analysed 860 observations (581 participants; age range: 55–95 years; 56.0% male; 93.6% White). Linear mixed models (LMMs) estimated fixed effects of age, creatinine, baseline BMI, sex, ethnicity, and group (Control vs. AD) on plasma p-tau181 concentration, with a random intercept for participant ID. Separate LMMs assessed covariate effects and interactions with group status.

Results

Analysis of ADNI data revealed a significant positive association between p-tau181 levels, group status, and creatinine in the fully adjusted LLM. Group status may have obscured the total effect of age on p-tau181, as its removal from the model resulted in a significant age effect. Single-variable models showed the positive association between either age, or creatinine and p-tau181 levels did not differ between control and AD groups. There was a significant negative association between BMI and plasma p-tau, which was stronger in AD versus control groups.

Conclusions

This study provides insights into the factors that may influence plasma p-tau181 levels. These findings underscore the need to account for clinical and demographic factors when interpreting p-tau181. Future research should validate these associations in diverse populations and explore underlying mechanisms.

Objective

With the increasing incidence of dementia, lifestyle interventions are key for long-term risk reduction. Understanding the psychological factors affecting lifestyle change motivation is crucial to developing effective policy strategies for dementia risk reduction. This study explores the moderating role of dementia-related fear on the relationship between perceived cognitive decline and engagement in dementia risk reduction behaviors.

Methods

A cross-sectional study was conducted among 200 Chinese community-dwelling middle-aged and older adults. Hierarchical regression and simple slope analysis were used to assess the moderating effect of dementia-related fear on the relationship between perceived cognitive decline and motivation to engage in dementia risk reduction behaviors.

Results

A significant correlation was found between perceived cognitive decline and increased motivation to engage in dementia risk reduction behaviors (r = 0.44). Dementia-related fear acted as a significant moderator; motivation was positively associated with low to moderate levels of fear, whereas this association diminished and became non-significant at higher levels of fear.

Conclusions

The findings suggest that while lower levels of dementia-related fear may be linked to increased motivation for engaging in risk reduction behaviors, elevated levels of fear do not appear to support such engagement. Rather than emphasizing the negative impacts of dementia, public health strategies should empower individuals with actionable messages to engage in dementia risk reduction behaviors.

Objectives

Interventions that enable people with dementia to retain some independence in activities of daily living (ADL) may delay transitions into residential care and offset sharp reductions in quality of life (QoL). The aim of this study was to estimate how effective a hypothetical intervention needs to be at preserving independence in home-dwelling people with dementia, to be cost-effective.

Methods

A decision-analytic model was constructed to compare costs and outcomes of a cohort of people with dementia in the United Kingdom and European Union over a 10-year period. At model entry, the cohort was distributed across low, moderate, or high levels of dependence. The impact of a hypothetical intervention that preserves independence was evaluated by reducing the proportion of people entering the model with moderate and high dependence. The model included costs for the intervention and health and social care resource use. Secondary analysis included estimated costs of informal care. Health benefit was measured as quality-adjusted life-years (QALYs).

Results

The cost of the intervention was £570/person. At this cost, an intervention that resulted in 7.5% of the sample entering the model in a lower level of dependence (compared with no intervention) was likely to be cost-effective (£8690/QALY). An intervention costing £250/person would only need a 2.5% effect and one costing £1000/person would need to have a 10% effect to be potentially cost-effective. Including informal care costs increased the size of the effect required for the intervention to be cost-effective because more of the care provided at lower levels of dependence is informal.

Conclusions

Preserving independence in people with dementia may be a cost-effective way to help them live well for longer. Our results provide a guide on costs and required effects for those developing interventions to preserve independence in people with dementia.

Introduction

Dementia is prevalent within Aboriginal and Torres Strait Islander communities but clients attending primary care often remain undiagnosed. This project aimed to develop a rapid dementia screen for primary care.

Methods

Logistic regression was used to identify candidate items from the Kimberley Indigenous Cognitive Assessment (KICA-Cog). The psychometric properties of different scales were assessed using receiver operating characteristic curve analysis and validated in a separate cohort.

Results

Four items in the KICA-Cog demonstrated high sensitivity (82.6%), specificity (83.2%) and area under the curve (AUC = 0.90; 95% CI: 0.87–0.94) for dementia at a cut-off point of 7/8 out of 10. This scale has favourable psychometrics (sensitivity 87.5%, specificity 80.9%, AUC = 0.92; 95% CI: 0.85–0.98) when validated in separate cohort.

Discussion

The proposed prototype tool, ready for community piloting and validation, may be useful in primary care to enable rapid cognitive screening as part of routine health care.

Background

Cognitive domains related to attention and executive functions (a set of cognitive processes that regulate, control, and manage other cognitive abilities) seem to influence the recognition of facial expressions in people with Alzheimer's disease (AD).

Purpose

We examined the relationship between facial expression recognition, global cognition and executive function in people with AD according to their cognitive level.

Research Design

In a cross-sectional design, we included 130 participants with AD divided into three groups based on their Mini-Mental State Examination (MMSE) scores: MMSE 1 (scores 23–28), MMSE 2 (scores 17–22), and MMSE 3 (scores 11–16). Facial expression recognition ability was analyzed using the Faces Test. Executive function was analyzed using the Trail Making Test (TMT), the Verbal Fluency Test (VFT), the Semantic Fluency Test (SFT), the Digit Span Forward (DSF) and Backward (DSB) tests, and the Clock Drawing Test (CDT).

Results

In MMSE 1 group difficulties in divided attention and cognitive flexibility impacted the accuracy of facial expression recognition. In the MMSE 2 group, facial expression recognition was related to impairment in working memory. In the MMSE 3 group, the impact on facial expression recognition was directly related to visuoconstructive abilities.

Conclusions

We observed that the executive resources involved in each evaluated group differed in terms of facial recognition task performance efficacy. Interventions at stimulating executive and visuoconstructive abilities in people with AD may contribute to better preservation of facial expression recognition.

Objectives

Latinos experience significant health disparities for Alzheimer's disease (AD) with an increased likelihood in developing the disease relative to non-Latino Whites. Our study sought to examine Latinos' beliefs about controlling the symptoms and progression of AD to identify gaps in community knowledge and improve understanding of culturally based perceptions of health and illness.

Methods

We conducted in-depth, semi-structured interviews in English or Spanish with 216 Latinos aged 40–60 years (average age 53 years) living in the neighborhoods of northern Manhattan. We asked them whether they believed there were interventions that could help control AD. The data was analyzed using content analysis.

Results

Most participants viewed medications as important in the management of AD, though they had limited specific knowledge about existing medications for AD. Some participants thought herbal and nutritional supplements could have some benefits. Many believed activities for mental stimulation could help enhance cognitive functioning. A few suggested that a healthy diet and exercise could help slow the progression of AD. Some participants believed that emotional wellness and degree of support influenced AD progression.

Conclusions

Limited knowledge of available medications and evidence-based non-medical approaches to control AD may adversely impact help-seeking behavior and use of effective management strategies among those with AD. Future interventions should strive to expand knowledge about ways to effectively manage and treat AD in Latino communities.

Trial Registration: The ClinicalTrials.gov ID is NCT04471779. The date registered was July 15, 2020