Pub Date : 2025-12-01Epub Date: 2025-12-08DOI: 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 : 2025-12-01Epub Date: 2025-12-22DOI: 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 : 2025-12-01Epub Date: 2025-12-10DOI: 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 : 2025-12-01Epub Date: 2025-12-02DOI: 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.
{"title":"Oropharyngeal dysphagia: a narrative review towards an integrated neurogeriatric perspective","authors":"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","doi":"10.1016/j.lanhl.2025.100794","DOIUrl":"10.1016/j.lanhl.2025.100794","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 12","pages":"Article 100794"},"PeriodicalIF":14.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688382","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}
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 : 2025-12-01Epub Date: 2025-12-12DOI: 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}
Pub Date : 2025-12-01Epub Date: 2025-12-22DOI: 10.1016/j.lanhl.2025.100804
Chun-Ting Yang PhD , James M Wilkins MD DPhil , Kevin T Pritchard PhD , Qiaoxi Chen PhD , Xiaojuan Liu PhD , Dae Hyun Kim MD ScD , Kueiyu Joshua Lin MD ScD
Background
Trazodone has emerged as a potentially safer alternative to atypical antipsychotic medications for managing delirium-related symptoms in older adults after hospital admission. This study aimed to compare safety outcomes in older adults who were prescribed trazodone versus atypical antipsychotic medication after hospital discharge.
Methods
This population-based cohort study was done using US Medicare data from Jan 1, 2013, to Dec 31, 2022, and Optum de-identified Clinformatics Data Mart Database data from Jan 1, 2013, to Aug 31, 2025, with a target trial emulation framework. Patients aged at least 65 years without psychiatric disorders who were prescribed a new trazodone or atypical antipsychotic medication (quetiapine, risperidone, or olanzapine) prescription within 30 days of hospital discharge with a claims-based delirium diagnosis were included. We applied propensity score overlap weighting to adjust for 162 covariates. The primary outcome was all-cause rehospitalisation. Secondary outcomes included rehospitalisation for delirium, falls (including fall-related emergency department visits), pneumonia, urinary tract infections, stroke, and all-cause mortality. Treatment-outcome associations were estimated using the Fine–Gray model for non-fatal outcomes (presented as subdistribution hazard ratio [SDHR]) and the Cox model for all-cause mortality (presented as hazard ratio [HR]). Estimates from the two databases were pooled using inverse-variance weighting.
Findings
11 678 trazodone and 29 590 atypical antipsychotic medication users were included. Compared with antipsychotic medications, trazodone was associated with lower risks of rehospitalisation (SDHR 0·95 [95% CI 0·91–0·98]), rehospitalisation for delirium (SDHR 0·80 [0·75–0·86]), urinary tract infection (SDHR 0·84 [0·72–0·99]), and all-cause mortality (HR 0·84 [0·79–0·90]); no significant difference was observed for falls (SDHR 0·93 [0·85–1·02]), pneumonia (SDHR 0·96 [0·79–1·16]), and stroke (SDHR 0·92 [0·77–1·11]). The reduced risk of rehospitalisation with trazodone was consistent when compared with risperidone (SDHR 0·89 [0·84–0·95]), and olanzapine (SDHR 0·88 [0·82–0·94]) but no difference was seen with quetiapine (SDHR 0·97 [0·93–1·01]).
Interpretation
These results revealed reduced risks of rehospitalisation and all-cause mortality associated with trazodone versus atypical antipsychotic medications. Trazodone is a potentially safer alternative to antipsychotic medications in the management of delirium-related symptoms after hospital discharge.
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Pub Date : 2025-12-01Epub Date: 2025-12-05DOI: 10.1016/j.lanhl.2025.100798
Federico Bellelli MD , Jeremy Raffin PhD , Prof Matteo Cesari MD PhD , Sophie Guyonnet PhD , David Furman PhD , Prof Yves Rolland MD PhD , Prof Bruno Vellas MD PhD , Prof Philipe de Souto Barreto PhD , IHU HealthAge INSPIRE Platform Group, IHU HealthAge Open Science group
<div><h3>Background</h3><div>Although pain singularly impacts most critical domains of health status, its relationship with intrinsic capacity has been poorly investigated. Inflammation is central to pain biology, and longitudinal evidence indicates that pain can amplify inflammatory activity over time. This study evaluated the cross-sectional association of pain with intrinsic capacity and its domains in a cohort of community-dwelling people across the lifespan, as well as the moderating role of the inflammatory ageing (iAge) clock in this association. The secondary objective was to explore whether the pain–intrinsic capacity associations varied as a function of age and sex.</div></div><div><h3>Methods</h3><div>The analyses included 971 participants from the INSPIRE-T cohort. INSPIRE-T is an ongoing 10-year observational study in Toulouse, France, that recruited individuals aged 20 years and older who were not affected by severe illness that could compromise life expectancy within 5 years (or within 1 year for individuals who were already disabled and at old age). Pain was assessed based on self-reported presence over the previous 8 days, using a numeric scale (0–4, where higher is worse). A composite intrinsic capacity score (calculated as the arithmetic mean of the scores across the five domains) and intrinsic capacity domains (locomotion, cognition, vitality, psychology, and sensory capacity, including visual and hearing capacities) were assessed. Estimates from the regression models should be interpreted inversely (eg, a positive regression coefficient indicates a negative association), except for the vitality domain. Multiple linear regressions analyses were conducted to examine the association of pain with intrinsic capacity and its domains, as well as the interaction with iAge (pain × iAge), age (pain × age) and sex (pain × sex). The INSPIRE Platform is registered with <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, <span><span>NCT04224038</span><svg><path></path></svg></span>.</div></div><div><h3>Findings</h3><div>Enrolment began on Oct 16, 2019, and the majority of participants were recruited by December, 2021. A total of 1014 individuals were recruited in the INSPIRE-T cohort; of those, 971 individuals (median age 64 years [IQR 48–77], range 20–102 years; 366 [38%] male and 605 female [62%] individuals) with complete pain data and intrinsic capacity evaluation data were included in the analysis. Both moderate pain (β 0·264, SE 0·076, p=0·0006) and intense pain (0·479, 0·105, p<0·0001) were negatively associated with intrinsic capacity values. Pain at all intensities, mild (0·512, 0·163, p=0·0017), moderate (1·111, 0·191, p<0·0001), or intense (1·532, 0·263, p<0·0001), was significantly associated with lower scores in the psychological domain. Intense pain was associated with reduced scores in all intrinsic capacity domains (locomotor: 0·857, 0·219, p<0·0001; vitality: –4·159, 1·742, p=0·017; cognitive:
背景：虽然疼痛会影响健康状态的大多数关键领域，但其与内在能力的关系却很少被研究。炎症是疼痛生物学的核心，纵向证据表明，随着时间的推移，疼痛会放大炎症活动。本研究评估了一组社区居民在整个生命周期中疼痛与内在能力及其域的横断面关联，以及炎症老化时钟在这种关联中的调节作用。第二个目的是探讨疼痛-内在能力的关联是否随年龄和性别的变化而变化。方法：分析了来自INSPIRE-T队列的971名参与者。INSPIRE-T是一项正在法国图卢兹进行的为期10年的观察性研究，招募年龄在20岁及以上的个体，这些个体没有可能在5年内影响预期寿命的严重疾病（或已经残疾和老年的个体在1年内）。疼痛的评估是基于自我报告的过去8天的存在，使用数字量表（0-4，越高越差）。综合内在能力得分（计算为五个领域得分的算术平均值）和内在能力领域（运动、认知、活力、心理和感觉能力，包括视觉和听觉能力）进行评估。回归模型的估计应该反向解释（例如，正回归系数表示负关联），除了活力域。采用多元线性回归分析疼痛与内在能力及其域的关系，以及与图像（疼痛×图像）、年龄（疼痛×年龄）和性别（疼痛×性别）的相互作用。INSPIRE平台已在ClinicalTrials.gov注册，注册号为NCT04224038。研究结果：招募于2019年10月16日开始，大多数参与者于2021年12月招募。在INSPIRE-T队列中共招募了1014名个体；其中971例患者（中位年龄64岁[IQR 48-77]，年龄范围20-102岁；男性366例（38%），女性605例（62%））具有完整的疼痛资料和内在能力评估资料纳入分析。中度疼痛（β 0.264, SE 0.076, p= 0.0006）和剧烈疼痛（0.479,0.105,p= 0.0006）解释：疼痛与内在能力下降有关，没有证据表明图像在这种关联中起调节作用。疼痛强度越高，在所有界定内在能力的领域得分越低，除了感觉领域。在中等强度下，这种关联在活力、运动和心理领域尤为明显。需要进一步的研究来确定有效的疼痛管理是否有助于防止内在能力的下降。资助：国家研究机构。
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