Pub Date : 2025-12-31DOI: 10.1016/j.lanhl.2025.100808
Esteban Calvo, Jose T Medina, Hanna Grol-Prokopczyk, Katherine Keyes, Alvaro Castillo-Carniglia, Antonia Díaz-Valdés, Tamara Otzen, Robin Richardson, Silvia Martins
Background: The experience of pain is highly prevalent among older adults worldwide. This study aimed to compare trends and social disparities in pain for middle aged and older adults (ie, those aged ≥50 years) across countries to help identify high-pain or high-disparity hotspots needing intervention, and low-pain or low-disparity locations or timepoints from which policy and practice lessons could be drawn.
Methods: Country-specific pain trends were estimated using longitudinal logistic regressions on harmonised data for 212 904 adults aged older than 50 years observed repeatedly from 1998 to 2018 in 22 countries across three continents.
Findings: Unadjusted pain prevalence was 43·21% (95% CI 43·10-43·33) across all countries and years pooled. Instrument-adjusted prevalence ranged from 26·70% (95% CI 25·52-27·88; Netherlands, 2006) to 59·20% (58·02-60·38; France, 2016). Over the decade 2006-16, when most countries were observed, prevalence substantially increased in 15 countries (12·01 percentage points), decreased in China (6·60 percentage points), and remained steady in six countries. Prevalence was higher among women, those with less education (ie, completed less than high school), and older respondents (those aged >60 years), though disparities varied substantially across countries. Disparities widened over time in some countries (eg, Spain), but remained stable, declined, or reversed in others (eg, Sweden). In 2016, Denmark had the lowest overall pain disparity index, while South Korea had the highest.
Interpretation: There was a substantial increase in pain prevalence among middle aged and older adults in most countries studied. Cross-country, temporal, and sociodemographic variation indicates pain should be treated as a population public health issue.
Funding: Agencia Nacional de Investigación y Desarrollo, National Institute on Aging.
背景:疼痛的经历在全世界的老年人中非常普遍。本研究旨在比较各国中老年人(即年龄≥50岁的人)疼痛的趋势和社会差异,以帮助确定需要干预的高疼痛或高差异热点,以及可以从中吸取政策和实践经验的低疼痛或低差异地点或时间点。方法:对1998年至2018年在三大洲22个国家反复观察的212904名50岁以上成年人的统一数据进行纵向logistic回归,估计了国家特定的疼痛趋势。结果:在所有国家和年份中,未经调整的疼痛患病率为43.21% (95% CI 43.10 - 43.33)。仪器校正后的患病率从26.70% (95% CI 25.52 - 27.88;荷兰,2006年)到59.20%(58.02 - 6038;法国,2016年)。在对大多数国家进行观察的2006- 2016年十年间,15个国家的患病率大幅上升(12.01个百分点),中国下降(6.60个百分点),6个国家保持稳定。妇女、受教育程度较低的人(即完成高中以下学业的人)和年龄较大的受访者(60岁以下的人)的患病率较高,尽管各国之间的差异很大。随着时间的推移,差距在一些国家(如西班牙)扩大,但在其他国家(如瑞典)保持稳定、下降或逆转。2016年,丹麦的整体疼痛差距指数最低,而韩国最高。解释:在大多数被研究的国家中,中老年人的疼痛患病率大幅增加。跨国家、时间和社会人口的差异表明,疼痛应被视为人口公共卫生问题。资助:国家机构Investigación y Desarrollo,国家老龄化研究所。
{"title":"International trends and social disparities in pain of adults aged 50 years and older in 22 countries across Europe, Asia, and the Americas: a longitudinal population-based study.","authors":"Esteban Calvo, Jose T Medina, Hanna Grol-Prokopczyk, Katherine Keyes, Alvaro Castillo-Carniglia, Antonia Díaz-Valdés, Tamara Otzen, Robin Richardson, Silvia Martins","doi":"10.1016/j.lanhl.2025.100808","DOIUrl":"https://doi.org/10.1016/j.lanhl.2025.100808","url":null,"abstract":"<p><strong>Background: </strong>The experience of pain is highly prevalent among older adults worldwide. This study aimed to compare trends and social disparities in pain for middle aged and older adults (ie, those aged ≥50 years) across countries to help identify high-pain or high-disparity hotspots needing intervention, and low-pain or low-disparity locations or timepoints from which policy and practice lessons could be drawn.</p><p><strong>Methods: </strong>Country-specific pain trends were estimated using longitudinal logistic regressions on harmonised data for 212 904 adults aged older than 50 years observed repeatedly from 1998 to 2018 in 22 countries across three continents.</p><p><strong>Findings: </strong>Unadjusted pain prevalence was 43·21% (95% CI 43·10-43·33) across all countries and years pooled. Instrument-adjusted prevalence ranged from 26·70% (95% CI 25·52-27·88; Netherlands, 2006) to 59·20% (58·02-60·38; France, 2016). Over the decade 2006-16, when most countries were observed, prevalence substantially increased in 15 countries (12·01 percentage points), decreased in China (6·60 percentage points), and remained steady in six countries. Prevalence was higher among women, those with less education (ie, completed less than high school), and older respondents (those aged >60 years), though disparities varied substantially across countries. Disparities widened over time in some countries (eg, Spain), but remained stable, declined, or reversed in others (eg, Sweden). In 2016, Denmark had the lowest overall pain disparity index, while South Korea had the highest.</p><p><strong>Interpretation: </strong>There was a substantial increase in pain prevalence among middle aged and older adults in most countries studied. Cross-country, temporal, and sociodemographic variation indicates pain should be treated as a population public health issue.</p><p><strong>Funding: </strong>Agencia Nacional de Investigación y Desarrollo, National Institute on Aging.</p>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":" ","pages":"100808"},"PeriodicalIF":14.6,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145896765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.lanhl.2025.100797
Xin Xia PhD , Prof Maria Eriksdotter MD , Prof Henrik Zetterberg MD , Prof Silke Kern MD , Tobias Skillbäck PhD , Marco Toccaceli Blasi MD , Prof Bengt Winblad MD , Jonathan K L Mak PhD , Alice Margherita Ornago MD , Elena Pinardi MD , Prof Román Romero Ortuño PhD , Prof Linus Jönsson MD
Background
This study aimed to examine the value of frailty status (defined by the frailty index) in informing the prognosis of people living with Alzheimer’s disease.
Methods
In this retrospective cohort study, we used the Swedish Registry for Cognitive/Dementia Disorders linked to other Swedish health-care registers to collect data from May 1, 2007, to Dec 31, 2020. We included people with mild cognitive impairment or Alzheimer’s disease dementia, both with cerebrospinal fluid (CSF) biomarkers supporting Alzheimer’s pathology. We excluded people living in an institution or those who did not have at least one Mini-Mental State Examination (MMSE). We constructed a 41-item frailty index, incorporating diseases, symptoms, polypharmacy, nutritional status, and care dependency. Individuals with frailty index scores of 0·25 or above were considered frail. The associations between frailty and MMSE trajectories, subsequent institutionalisation, and mortality were evaluated by jointly modelling longitudinal and survival data. We also examined whether frailty could modify the associations between CSF amyloid β42, phosphorylated tau181, and total tau and cognitive decline.
Findings
The study included 7251 individuals (mean age 72·7 years, 4271 [58·9%] females, 2980 [41·1%] males). Frailty was associated with a 0·723-point (95% CI 0·250–1·196) lower baseline MMSE but not with the rate of MMSE decline. Frailty was associated with a hazard ratio of 1·91 (1·43–2·54) for institutionalisation and 2·41 (1·73–3·33) for mortality. Individuals living with frailty had a 1·3-year (0·9–1·7) shorter lifespan and a 1·0-year (0·8–1·3) shorter non-institutionalised lifespan. Associations between CSF biomarkers and MMSE trajectories did not differ by frailty status.
Interpretation
Frailty, measured by the frailty index, predicted institutionalisation and mortality in people with Alzheimer’s disease, but its absence of association with cognitive decline suggests neurodegeneration as the primary driver.
Funding
Innovative Health Initiative Joint Undertaking and Vinnova.
{"title":"Frailty and prognosis of biomarker-confirmed Alzheimer’s disease: a Swedish, register-based, retrospective cohort study","authors":"Xin Xia PhD , Prof Maria Eriksdotter MD , Prof Henrik Zetterberg MD , Prof Silke Kern MD , Tobias Skillbäck PhD , Marco Toccaceli Blasi MD , Prof Bengt Winblad MD , Jonathan K L Mak PhD , Alice Margherita Ornago MD , Elena Pinardi MD , Prof Román Romero Ortuño PhD , Prof Linus Jönsson MD","doi":"10.1016/j.lanhl.2025.100797","DOIUrl":"10.1016/j.lanhl.2025.100797","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to examine the value of frailty status (defined by the frailty index) in informing the prognosis of people living with Alzheimer’s disease.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, we used the Swedish Registry for Cognitive/Dementia Disorders linked to other Swedish health-care registers to collect data from May 1, 2007, to Dec 31, 2020. We included people with mild cognitive impairment or Alzheimer’s disease dementia, both with cerebrospinal fluid (CSF) biomarkers supporting Alzheimer’s pathology. We excluded people living in an institution or those who did not have at least one Mini-Mental State Examination (MMSE). We constructed a 41-item frailty index, incorporating diseases, symptoms, polypharmacy, nutritional status, and care dependency. Individuals with frailty index scores of 0·25 or above were considered frail. The associations between frailty and MMSE trajectories, subsequent institutionalisation, and mortality were evaluated by jointly modelling longitudinal and survival data. We also examined whether frailty could modify the associations between CSF amyloid β<sub>42</sub>, phosphorylated tau<sub>181</sub>, and total tau and cognitive decline.</div></div><div><h3>Findings</h3><div>The study included 7251 individuals (mean age 72·7 years, 4271 [58·9%] females, 2980 [41·1%] males). Frailty was associated with a 0·723-point (95% CI 0·250–1·196) lower baseline MMSE but not with the rate of MMSE decline. Frailty was associated with a hazard ratio of 1·91 (1·43–2·54) for institutionalisation and 2·41 (1·73–3·33) for mortality. Individuals living with frailty had a 1·3-year (0·9–1·7) shorter lifespan and a 1·0-year (0·8–1·3) shorter non-institutionalised lifespan. Associations between CSF biomarkers and MMSE trajectories did not differ by frailty status.</div></div><div><h3>Interpretation</h3><div>Frailty, measured by the frailty index, predicted institutionalisation and mortality in people with Alzheimer’s disease, but its absence of association with cognitive decline suggests neurodegeneration as the primary driver.</div></div><div><h3>Funding</h3><div>Innovative Health Initiative Joint Undertaking and Vinnova.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 12","pages":"Article 100797"},"PeriodicalIF":14.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.lanhl.2025.100783
Vigdis Sveinsdottir PhD , Jörg Assmus PhD , Prof Justine Schneider PhD , Prof Felicity A Baker PhD , Burçin Uçaner PhD , Prof Gunter Kreutz PhD , Monika Geretsegger PhD , Naomi Rasing PhD , Jodie Bloska MA , Phoebe A Stretton-Smith MMusThrp , Young-Eun C Lee PhD , Jo Dugstad Wake PhD , Prof Helen Odell-Miller PhD , Jeanette Tamplin PhD , Annemieke C Vink PhD , Joanne Ablewhite PhD , Johanna Neuser MSc , Ulrike Frischen Dr rer Nat , Prof Antje Timmer PhD , Prof Thomas Wosch PhD , Prof Christian Gold PhD
<div><h3>Background</h3><div>Dementia and depression are among the leading causes of global disease burden. Effective and scalable interventions are needed to address the effect of these conditions, and music interventions are a promising non-pharmacological approach. The aim of this study was to determine the effectiveness of music interventions on depressive symptoms among care home residents with dementia in Australia, Germany, the Netherlands, Norway, Türkiye, and the UK.</div></div><div><h3>Methods</h3><div>Music Interventions for Dementia and Depression in Elderly care was a large, multinational, cluster-randomised controlled trial with a 2 × 2 factorial design to examine the effects of group music therapy, recreational choir singing, or both compared with standard care. The trial was done in 86 care home units across Australia, Germany, the Netherlands, Norway, Türkiye, and the UK. Care home units were required to host at least ten residents who met the inclusion criteria. Participants were required to be aged 65 years or older; a full-time resident in a participating care home unit; have dementia as indicated by a Clinical Dementia Rating score of 0·5–3 and a Mini-Mental State Examination score of 26 or less; have mild depressive symptoms as indicated by a Montgomery–Åsberg Depression Rating Scale (MADRS) score of at least 8; and a clinical diagnosis of dementia. Care home units with residents with dementia and depressive symptoms were randomly assigned (1:1:1:1; block randomisation stratified by site, using a computer-generated list) to group music therapy, recreational choir singing, a combination of these strategies, or standard care. The primary outcome was MADRS assessed at 6 months in the intention-to-treat population, which included all participants with available data. Assessors were masked but care staff, intervention providers, and residents were not masked due to the nature of the intervention. Intervention effects were analysed with ANCOVA for the total sample and per country. The trial was registered at <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, <span><span>NCT03496675</span><svg><path></path></svg></span>, and is completed.</div></div><div><h3>Findings</h3><div>Between July 18, 2018, and Feb 1, 2023, 86 care home units with 1021 residents were enrolled and randomly assigned to one of the four groups. 22 care home units with 258 residents were randomly assigned to group music therapy, 22 care home units with 281 residents were allocated to recreational choir singing, 21 care home units with 244 residents were assigned to a combination of both group music therapy and recreational choir singing, and 21 care home units with 238 residents were assigned to standard care. The mean age of residents was 85·6 years (SD 7·4); most residents (747 [73·2%]) were female and 274 (26·8%) were male. Intention-to-treat analysis of 751 residents with data at 6 months showed no significant effect on MADRS scores of eit
{"title":"Clinical effectiveness of music interventions for dementia and depression in older people (MIDDEL): a multinational, cluster-randomised controlled trial","authors":"Vigdis Sveinsdottir PhD , Jörg Assmus PhD , Prof Justine Schneider PhD , Prof Felicity A Baker PhD , Burçin Uçaner PhD , Prof Gunter Kreutz PhD , Monika Geretsegger PhD , Naomi Rasing PhD , Jodie Bloska MA , Phoebe A Stretton-Smith MMusThrp , Young-Eun C Lee PhD , Jo Dugstad Wake PhD , Prof Helen Odell-Miller PhD , Jeanette Tamplin PhD , Annemieke C Vink PhD , Joanne Ablewhite PhD , Johanna Neuser MSc , Ulrike Frischen Dr rer Nat , Prof Antje Timmer PhD , Prof Thomas Wosch PhD , Prof Christian Gold PhD","doi":"10.1016/j.lanhl.2025.100783","DOIUrl":"10.1016/j.lanhl.2025.100783","url":null,"abstract":"<div><h3>Background</h3><div>Dementia and depression are among the leading causes of global disease burden. Effective and scalable interventions are needed to address the effect of these conditions, and music interventions are a promising non-pharmacological approach. The aim of this study was to determine the effectiveness of music interventions on depressive symptoms among care home residents with dementia in Australia, Germany, the Netherlands, Norway, Türkiye, and the UK.</div></div><div><h3>Methods</h3><div>Music Interventions for Dementia and Depression in Elderly care was a large, multinational, cluster-randomised controlled trial with a 2 × 2 factorial design to examine the effects of group music therapy, recreational choir singing, or both compared with standard care. The trial was done in 86 care home units across Australia, Germany, the Netherlands, Norway, Türkiye, and the UK. Care home units were required to host at least ten residents who met the inclusion criteria. Participants were required to be aged 65 years or older; a full-time resident in a participating care home unit; have dementia as indicated by a Clinical Dementia Rating score of 0·5–3 and a Mini-Mental State Examination score of 26 or less; have mild depressive symptoms as indicated by a Montgomery–Åsberg Depression Rating Scale (MADRS) score of at least 8; and a clinical diagnosis of dementia. Care home units with residents with dementia and depressive symptoms were randomly assigned (1:1:1:1; block randomisation stratified by site, using a computer-generated list) to group music therapy, recreational choir singing, a combination of these strategies, or standard care. The primary outcome was MADRS assessed at 6 months in the intention-to-treat population, which included all participants with available data. Assessors were masked but care staff, intervention providers, and residents were not masked due to the nature of the intervention. Intervention effects were analysed with ANCOVA for the total sample and per country. The trial was registered at <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, <span><span>NCT03496675</span><svg><path></path></svg></span>, and is completed.</div></div><div><h3>Findings</h3><div>Between July 18, 2018, and Feb 1, 2023, 86 care home units with 1021 residents were enrolled and randomly assigned to one of the four groups. 22 care home units with 258 residents were randomly assigned to group music therapy, 22 care home units with 281 residents were allocated to recreational choir singing, 21 care home units with 244 residents were assigned to a combination of both group music therapy and recreational choir singing, and 21 care home units with 238 residents were assigned to standard care. The mean age of residents was 85·6 years (SD 7·4); most residents (747 [73·2%]) were female and 274 (26·8%) were male. Intention-to-treat analysis of 751 residents with data at 6 months showed no significant effect on MADRS scores of eit","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 12","pages":"Article 100783"},"PeriodicalIF":14.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145744907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.lanhl.2025.100803
Melissa Melville MSci , Lexi He MSci , Roopal Desai DClinPsy PhD , Primrose Nyamayaro PhD , Prof Chris Fox MD , Kavita U Kothari MPH , Patrick Condron GradDip , Miao Miao PhD , Prof Martha Hickey PhD , Prof Aimee Spector DClinPsy PhD
Background
Globally, dementia disproportionately affects women. Changes in circulating sex steroids over the menopause transition might contribute to this sex difference. Menopause hormone therapy (MHT) is recommended by the UK National Institute for Health and Care Excellence to manage menopausal symptoms, but whether MHT use affects dementia risk and how this association might vary by age at menopause is unclear. We aimed to assess whether MHT (vs no MHT) affects the risk of mild cognitive impairment or dementia in peri-menopausal or post-menopausal women, including those with premature ovarian insufficiency or early menopause (with normal cognition or mild cognitive impairment), and whether MHT type, duration, or age at initiation influence this risk.
Methods
We systematically searched MEDLINE via OVID, Embase via Elsevier, Cochrane via OVID, and PsycINFO via OVID for systematic reviews published between Jan 1, 2000, and Dec 19, 2024. As no existing review met our quality or scope criteria, we proceeded to conduct a systematic review and meta-analysis of primary studies published from Jan 1, 2000, to Oct 20, 2025. Eligible primary studies included randomised controlled trials (RCTs), non-randomised intervention studies, and prospective observational studies examining the association between MHT—including oestrogen-only MHT, combined MHT, testosterone, and tibolone—and incident mild cognitive impairment or dementia. Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2 and ROBINS-E, with certainty of evidence rated using GRADE. Meta-analyses pooled relative risk estimates in a random-effects model. The protocol was preregistered on PROSPERO (CRD42025639384).
Findings
Of 5914 records, ten studies (one RCT and nine observational studies) with a total of 1 016 055 participants were included. Certainty of evidence ranged from moderate to very low. No included studies examined testosterone or use in premature ovarian insufficiency. No significant association was found between MHT use and risk of mild cognitive impairment or dementia. Subgroup analyses by timing, duration, and type of MHT showed no significant effects.
Interpretation
This review found no evidence that MHT use either increases or decreases the risk of dementia in post-menopausal women. This reinforces current clinical guidance, that MHT prescription should be based on other perceived benefits and risks and not for dementia prevention. High-quality, long-term studies are needed to clarify the role of MHT and dementia risk, particularly regarding formulation, dose, route, timing, and duration of treatment, with a focus on women with premature ovarian insufficiency, early menopause, or mild cognitive impairment.
{"title":"Menopause hormone therapy and risk of mild cognitive impairment or dementia: a systematic review and meta-analysis","authors":"Melissa Melville MSci , Lexi He MSci , Roopal Desai DClinPsy PhD , Primrose Nyamayaro PhD , Prof Chris Fox MD , Kavita U Kothari MPH , Patrick Condron GradDip , Miao Miao PhD , Prof Martha Hickey PhD , Prof Aimee Spector DClinPsy PhD","doi":"10.1016/j.lanhl.2025.100803","DOIUrl":"10.1016/j.lanhl.2025.100803","url":null,"abstract":"<div><h3>Background</h3><div>Globally, dementia disproportionately affects women. Changes in circulating sex steroids over the menopause transition might contribute to this sex difference. Menopause hormone therapy (MHT) is recommended by the UK National Institute for Health and Care Excellence to manage menopausal symptoms, but whether MHT use affects dementia risk and how this association might vary by age at menopause is unclear. We aimed to assess whether MHT (<em>vs</em> no MHT) affects the risk of mild cognitive impairment or dementia in peri-menopausal or post-menopausal women, including those with premature ovarian insufficiency or early menopause (with normal cognition or mild cognitive impairment), and whether MHT type, duration, or age at initiation influence this risk.</div></div><div><h3>Methods</h3><div>We systematically searched MEDLINE via OVID, Embase via Elsevier, Cochrane via OVID, and PsycINFO via OVID for systematic reviews published between Jan 1, 2000, and Dec 19, 2024. As no existing review met our quality or scope criteria, we proceeded to conduct a systematic review and meta-analysis of primary studies published from Jan 1, 2000, to Oct 20, 2025. Eligible primary studies included randomised controlled trials (RCTs), non-randomised intervention studies, and prospective observational studies examining the association between MHT—including oestrogen-only MHT, combined MHT, testosterone, and tibolone—and incident mild cognitive impairment or dementia. Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2 and ROBINS-E, with certainty of evidence rated using GRADE. Meta-analyses pooled relative risk estimates in a random-effects model. The protocol was preregistered on PROSPERO (CRD42025639384).</div></div><div><h3>Findings</h3><div>Of 5914 records, ten studies (one RCT and nine observational studies) with a total of 1 016 055 participants were included. Certainty of evidence ranged from moderate to very low. No included studies examined testosterone or use in premature ovarian insufficiency. No significant association was found between MHT use and risk of mild cognitive impairment or dementia. Subgroup analyses by timing, duration, and type of MHT showed no significant effects.</div></div><div><h3>Interpretation</h3><div>This review found no evidence that MHT use either increases or decreases the risk of dementia in post-menopausal women. This reinforces current clinical guidance, that MHT prescription should be based on other perceived benefits and risks and not for dementia prevention. High-quality, long-term studies are needed to clarify the role of MHT and dementia risk, particularly regarding formulation, dose, route, timing, and duration of treatment, with a focus on women with premature ovarian insufficiency, early menopause, or mild cognitive impairment.</div></div><div><h3>Funding</h3><div>The Public Health Agency of Canada.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 12","pages":"Article 100803"},"PeriodicalIF":14.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.lanhl.2025.100799
Andreea Alexandra Piriu , Aleksandra Torbica
{"title":"Measuring what matters in ageing societies: integrating dying-well and living-well metrics for resilient health systems","authors":"Andreea Alexandra Piriu , Aleksandra Torbica","doi":"10.1016/j.lanhl.2025.100799","DOIUrl":"10.1016/j.lanhl.2025.100799","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 12","pages":"Article 100799"},"PeriodicalIF":14.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.lanhl.2025.100794
Bendix Labeit MD , Sriramya Lapa PhD , Gero Lueg MD , Rebecca Joebges MD , Jule Hofacker MSc , Paul Muhle MD , Prof Sonja Suntrup-Krueger MD , Cornelius J Werner MD , Stefanie Schreiber MD , Prof Rainer Wirth MD , Tobias Warnecke MD , Rainer Dziewas MD , Prof Sven G Meuth MD
Oropharyngeal dysphagia, prevalent in neurogeriatric populations, increases the risks of malnutrition, pneumonia, and mortality. Oropharyngeal dysphagia manifests as a multi-aetiological syndrome with diverse phenotypes. We advocate for a neurogeriatric perspective that integrates specific neurological insights with geriatric care principles to improve dysphagia management. This approach highlights the diagnostic value of disease-specific neurological dysphagia manifestations and recognises the condition as a potential target for neurological therapies, as shown by the benefits that acetylcholinesterase inhibitors in myasthenia gravis and dopaminergic agents in Parkinson's disease have against the syndrome. Age-related factors such as presbyphagia, which includes reduced pharyngeal sensation, sarcopenia, and decreased neuroplasticity, further contribute to the pathophysiology of oropharyngeal dysphagia. Cross-disease treatment strategies encompass oral hygiene, nutritional support, dietary modifications, individualised interventions to improve swallowing physiology, and emerging neurostimulation techniques that are currently under investigation. Current research aims to refine assessment protocols tailored to these interventions, identify outcome predictors to contextualise dysphagia findings, and evaluate the potential of neurostimulation or pharmacological agents, with the aim to improve quality of life and reduce mortality.
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The 2024 Lancet Commission report on dementia identified 14 modifiable dementia risk factors. The Norwegian HUNT study uniquely includes data collection of all 14 risk factors in the same individuals throughout adulthood, as well as a study-specific dementia diagnosis. We aimed to evaluate the potential for dementia prevention associated with these 14 risk factors, along with three additional sociodemographic risk factors in this retrospective cohort.
Methods
This retrospective cohort study included data on participants with study-specific diagnosis from the HUNT4 70+ study (2017–19) and was linked with national administrative registries (1960–2018) and earlier HUNT surveys (1984–2008) with data on dementia risk factors at ages 35–92 years. Inverse probability weighting was applied to account for non-response. Logistic regression estimated dementia risk associated with exposure to less education in early adult life (age <45 years), hearing loss, high LDL cholesterol, depression, traumatic brain injury, physical inactivity, diabetes, smoking, hypertension, obesity, excessive alcohol use in midlife (age 45–65 years), and social isolation, air pollution, and vision loss in late life (age >65 years). Midlife occupational physical activity and marital and employment status were added to the Lancet model. The potential for dementia prevention was assessed using population attributable fraction (PAF).
Findings
Between Sept 1, 2017, and Feb 28, 2019, 19 403 individuals were invited to participate and 9745 participants (1525 with dementia, 8220 without dementia) were included. 4445 (45·6%) of 9745 participants were male and 5300 (54·4%) were female. The total PAF for the 14 Lancet risk factors was 50·9% (95% CI 37·7–61·4). Including family-related and work-related risk factors increased the PAF to 54·9% (42·3–64·7; p<0·0001). When these factors were added for women, the total PAF increased from 48·0% (95% CI 29·4–61·7) to 52·2% (34·2–65·3; p=0·0090), whereas no significant change was observed in men (56·2% [95% CI 35·5–70·2] to 56·7 [95% CI 36·1–70·6]; p=0·71).
Interpretation
Addressing all 14 Lancet risk factors could prevent over half of all dementia cases. Adding factors related to marital and occupational status offers additional preventive potential, particularly among women.
Funding
The National Institutes of Health and NRC-ATWORK.
2024年《柳叶刀》委员会关于痴呆症的报告确定了14种可改变的痴呆症风险因素。挪威HUNT研究独特地收集了同一个体在整个成年期的所有14种风险因素的数据,以及研究特定的痴呆诊断。我们的目的是在回顾性队列中评估与这14个危险因素以及另外3个社会人口危险因素相关的痴呆症预防潜力。该回顾性队列研究纳入了HUNT4 70+研究(2017-19)中具有研究特异性诊断的参与者的数据,并与国家行政登记处(1960-2018)和早期HUNT调查(1984-2008)的35-92岁痴呆危险因素数据相关联。应用逆概率加权来解释无响应。Logistic回归估计痴呆风险与成年早期(45岁)受教育程度较低、听力损失、高LDL胆固醇、抑郁症、创伤性脑损伤、缺乏体育锻炼、糖尿病、吸烟、高血压、肥胖、中年(45 - 65岁)过度饮酒以及晚年(65岁)的社会孤立、空气污染和视力丧失有关。中年人的职业体育活动、婚姻和就业状况也被加入到《柳叶刀》模型中。使用人口归因分数(PAF)评估预防痴呆的潜力。在2017年9月1日至2019年2月28日期间,19403人被邀请参加,9745名参与者(1525名痴呆患者,8220名无痴呆患者)被纳入研究。9745名参与者中男性4445人(45.6%),女性5300人(54.4%)。14种《柳叶刀》危险因素的总PAF为50.9% (95% CI 37.7 - 64.1)。包括家庭相关和工作相关的危险因素使PAF增加到54.9% (44.3 - 64.7;p< 0.0001)。当在女性中加入这些因素时,总PAF从48.0% (95% CI 29.4 - 61.7)增加到52.2% (34.2 - 65.3,p= 0.0090),而在男性中没有显著变化(56.2% [95% CI 35.5 - 70.2]到56.7 [95% CI 36.1 - 70.6], p= 0.71)。解决所有14个《柳叶刀》风险因素可以预防一半以上的痴呆症病例。加上与婚姻和职业状况有关的因素,提供了额外的预防潜力,特别是在妇女中。资助美国国立卫生研究院和NRC-ATWORK。
{"title":"Potentially modifiable risk factors for dementia in Norway (HUNT4 70+): a retrospective cohort study","authors":"Prof Merete Ellingjord-Dale PhD , Prof Bjørn Heine Strand PhD , Prof Vegard Skirbekk PhD , Prof Bernt Bratsberg PhD , Prof Teferi Mekonnen PhD , Prof Ekaterina Zotcheva PhD , Prof Geir Selbæk MD , Prof Yaakov Stern PhD , Prof Asta Kristine Håberg MD , Prof Bo Engdahl PhD","doi":"10.1016/j.lanhl.2025.100802","DOIUrl":"10.1016/j.lanhl.2025.100802","url":null,"abstract":"<div><h3>Background</h3><div>The 2024 <em>Lancet</em> Commission report on dementia identified 14 modifiable dementia risk factors. The Norwegian HUNT study uniquely includes data collection of all 14 risk factors in the same individuals throughout adulthood, as well as a study-specific dementia diagnosis. We aimed to evaluate the potential for dementia prevention associated with these 14 risk factors, along with three additional sociodemographic risk factors in this retrospective cohort.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included data on participants with study-specific diagnosis from the HUNT4 70+ study (2017–19) and was linked with national administrative registries (1960–2018) and earlier HUNT surveys (1984–2008) with data on dementia risk factors at ages 35–92 years. Inverse probability weighting was applied to account for non-response. Logistic regression estimated dementia risk associated with exposure to less education in early adult life (age <45 years), hearing loss, high LDL cholesterol, depression, traumatic brain injury, physical inactivity, diabetes, smoking, hypertension, obesity, excessive alcohol use in midlife (age 45–65 years), and social isolation, air pollution, and vision loss in late life (age >65 years). Midlife occupational physical activity and marital and employment status were added to the <em>Lancet</em> model. The potential for dementia prevention was assessed using population attributable fraction (PAF).</div></div><div><h3>Findings</h3><div>Between Sept 1, 2017, and Feb 28, 2019, 19 403 individuals were invited to participate and 9745 participants (1525 with dementia, 8220 without dementia) were included. 4445 (45·6%) of 9745 participants were male and 5300 (54·4%) were female. The total PAF for the 14 <em>Lancet</em> risk factors was 50·9% (95% CI 37·7–61·4). Including family-related and work-related risk factors increased the PAF to 54·9% (42·3–64·7; p<0·0001). When these factors were added for women, the total PAF increased from 48·0% (95% CI 29·4–61·7) to 52·2% (34·2–65·3; p=0·0090), whereas no significant change was observed in men (56·2% [95% CI 35·5–70·2] to 56·7 [95% CI 36·1–70·6]; p=0·71).</div></div><div><h3>Interpretation</h3><div>Addressing all 14 <em>Lancet</em> risk factors could prevent over half of all dementia cases. Adding factors related to marital and occupational status offers additional preventive potential, particularly among women.</div></div><div><h3>Funding</h3><div>The National Institutes of Health and NRC-ATWORK.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 12","pages":"Article 100802"},"PeriodicalIF":14.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145847559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.lanhl.2025.100806
Nicholas R Jones , Margaret Smith , Yaling Yang , F D Richard Hobbs , Clare J Taylor
{"title":"Temporality might matter in people with atrial fibrillation and heart failure","authors":"Nicholas R Jones , Margaret Smith , Yaling Yang , F D Richard Hobbs , Clare J Taylor","doi":"10.1016/j.lanhl.2025.100806","DOIUrl":"10.1016/j.lanhl.2025.100806","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 12","pages":"Article 100806"},"PeriodicalIF":14.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145764150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}