Global rural health disparities in Alzheimer's disease and related dementias: State of the science

Wiese, Lisa Ann Kirk; Gibson, Allison; Guest, Marc Aaron; Nelson, Amy R.; Weaver, Raven; Gupta, Aditi; Carmichael, Owen; Lewis, Jordan P.; Lindauer, Allison; Loi, Samantha; Peterson, Rachel; Radford, Kylie; Rhodus, Elizabeth K.; Wong, Christina G.; Zuelsdorff, Megan; Saidi, Ladan Ghazi; Valdivieso‐Mora, Esmeralda; Franzen, Sanne; Pope, Caitlin N.; Killian, Timothy S.; Shrestha, Hom L.; Heyn, Patricia C.; Ng, Ted Kheng Siang; Prusaczyk, Beth; John, Samantha; Kulshreshtha, Ambar; Sheffler, Julia L.; Besser, Lilah; Daniel, Valerie; Tolea, Magdalena I.; Miller, Justin; Musyimi, Christine; Corkey, Jon; Yank, Veronica; Williams, Christine L; Rahemi, Zahra; Park, JuYoung; Magzamen, Sheryl; Newton, Robert L.; Harrington, Candace; Flatt, Jason D.; Arora, Sonakshi; Walter, Sarah; Griffin, Percy; Babulal, Ganesh M.

doi:10.1002/alz.13104

Cited by 19 publications

(15 citation statements)

References 254 publications

(382 reference statements)

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“… 64 , 65 Vascular dementia, the second most diagnosed subtype (up to 20% of cases), often coexists with and is incorrectly diagnosed as Alzheimer’s disease. 66 , 67 The remaining dementias are typically categorized as Lewy body, frontotemporal, or alcohol-related. 68 …”

Section: Results Of the Reviewed Studiesmentioning

confidence: 99%

Alcohol Use Disorder and Dementia: A Review

Zahr

2024

ARCR

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PURPOSE By 2040, 21.6% of Americans will be over age 65, and the population of those older than age 85 is estimated to reach 14.4 million. Although not causative, older age is a risk factor for dementia: every 5 years beyond age 65, the risk doubles; approximately one-third of those older than age 85 are diagnosed with dementia. As current alcohol consumption among older adults is significantly higher compared to previous generations, a pressing question is whether drinking alcohol increases the risk for Alzheimer’s disease or other forms of dementia. SEARCH METHODS Databases explored included PubMed, Web of Science, and ScienceDirect. To accomplish this narrative review on the effects of alcohol consumption on dementia risk, the literature covered included clinical diagnoses, epidemiology, neuropsychology, postmortem pathology, neuroimaging and other biomarkers, and translational studies. Searches conducted between January 12 and August 1, 2023, included the following terms and combinations: “aging,” “alcoholism,” “alcohol use disorder (AUD),” “brain,” “CNS,” “dementia,” “Wernicke,” “Korsakoff,” “Alzheimer,” “vascular,” “frontotemporal,” “Lewy body,” “clinical,” “diagnosis,” “epidemiology,” “pathology,” “autopsy,” “postmortem,” “histology,” “cognitive,” “motor,” “neuropsychological,” “magnetic resonance,” “imaging,” “PET,” “ligand,” “degeneration,” “atrophy,” “translational,” “rodent,” “rat,” “mouse,” “model,” “amyloid,” “neurofibrillary tangles,” “α-synuclein,” or “presenilin.” When relevant, “species” (i.e., “humans” or “other animals”) was selected as an additional filter. Review articles were avoided when possible. SEARCH RESULTS The two terms “alcoholism” and “aging” retrieved about 1,350 papers; adding phrases—for example, “postmortem” or “magnetic resonance”—limited the number to fewer than 100 papers. Using the traditional term, “alcoholism” with “dementia” resulted in 876 citations, but using the currently accepted term “alcohol use disorder (AUD)” with “dementia” produced only 87 papers. Similarly, whereas the terms “Alzheimer’s” and “alcoholism” yielded 318 results, “Alzheimer’s” and “alcohol use disorder (AUD)” returned only 40 citations. As pertinent postmortem pathology papers were published in the 1950s and recent animal models of Alzheimer’s disease were created in the early 2000s, articles referenced span the years 1957 to 2024. In total, more than 5,000 articles were considered; about 400 are herein referenced. DISCUSSION AND CONCLUSIONS Chronic alcohol misuse accelerates brain aging and contributes to cognitive impairments, including those in the mnemonic domain. The consensus among studies from multiple disciplines, however, is that alcohol misuse can increase the risk for dementia, but not necessarily Alzheimer’s disease. Key issues to consider include the reversibility of brain damage following abstinence from chronic alcohol misuse compared to the degenerative and progressive course of ...

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Section: Results Of the Reviewed Studiesmentioning

confidence: 99%

Alcohol Use Disorder and Dementia: A Review

Zahr

2024

ARCR

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“…The major strengths of our large-scale study include the community-based study design that engaged rural-dwelling older adults in China who had received no or very limited school education, a sociodemographic group that has been underrepresented in research on dementia and brain aging 46 and the objective assessment of sleep duration. In addition, using multimodal biomarkers for different brain pathologies assessed with the state-of-the-art techniques (e.g.…”

Section: Discussionmentioning

confidence: 99%

Association of objective sleep duration with cognition and brain aging biomarkers in older adults

Tang,

Liu,

Ren

et al. 2024

Brain Communications

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The neuropathological mechanisms underlying the association between sleep duration and mild cognitive impairment (MCI) remain poorly understood. This population-based study included 2032 dementia-free people (age ≥ 60 years; 55.1% women) derived from participants in the Multimodal Interventions to Delay Dementia and Disability in Rural China; of these, data were available in 841 participants for Alzheimer’s plasma biomarkers (e.g., amyloid-β[Aβ], total tau, and neurofilament light chain), 1044 for serum microvascular biomarkers (e.g., soluble adhesion molecules), and 834 for brain MRI biomarkers (e.g., whiter matter, grey matter, hippocampus, lacunes, enlarged perivascular spaces [EPVS], and white matter hyperintensity [WMH]). We used electrocardiogram-based cardiopulmonary coupling analysis to measure sleep duration, a neuropsychological test battery to assess cognitive function, and the Petersen’s criteria to define MCI. Data were analysed with multivariable logistic and general linear models. In the total sample (n = 2032), 510 participants were defined with MCI, including 438 with amnestic MCI and 72 with non-amnestic MCI. Long sleep duration (>8 vs. 6-8 hours) was significantly associated with increased likelihoods of MCI and non-amnestic MCI, and lower scores in global cognition, verbal fluency, attention, and executive function (Bonferroni-corrected P < .05). In the subsamples, long sleep duration was associated with higher plasma Aβ40 and total tau, a lower Aβ42/Aβ40 ratio, and smaller grey matter volume (Bonferroni-corrected P < .05). Sleep duration was not significantly associated with serum soluble adhesion molecules, WMH volume, global EPVS, and lacunes (P > .05). Alzheimer’s and neurodegenerative pathologies may represent common pathways linking long sleep duration with MCI and low cognition in older adults.

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“…Our large‐scale population‐based study engaged rural‐dwelling older adults in China in a low socioeconomic position who received no or very limited formal education, a sociodemographic group that has been substantially underrepresented in epidemiological and clinical research on dementia and AD. 13 Furthermore, the integration of comprehensive epidemiological, clinical, and cognitive data with AD‐related plasma biomarkers in a subsample allows us to explore the potential neuropathological mechanisms linking multimorbidity load and clusters with cognitive phenotypes. However, our study also has limitations.…”

Section: Discussionmentioning

confidence: 99%

“…This is relevant given that epidemiological features (eg, prevalence, distribution, and risk factors) of chronic conditions and dementia disorders differ considerably between high-income and low-and middle-income countries as well as between urban and rural populations. [10][11][12][13] Some chronic conditions tend to occur together in older adults due to shared risk factors or common pathophysiological mechanisms, 14,15 so it is important to define different clusters of multimorbidity when investigating multimorbidity. 16 Indeed, previous studies showed that the associations of multimorbidity with dementia varied by different patterns of multimorbidity, 4 suggesting the importance of assessing specific disease clusters when studying the relationship of multimorbidity with cognitive phenotypes.…”

Section: Introductionmentioning

confidence: 99%

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Multimorbidity, cognitive phenotypes, and Alzheimer's disease plasma biomarkers in older adults: A population‐based study

Ren,

Li,

Tian

et al. 2023

Alzheimer's & Dementia

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INTRODUCTIONTo examine the burden and clusters of multimorbidity in association with mild cognitive impairment (MCI), dementia, and Alzheimer's disease (AD)‐related plasma biomarkers among older adults.METHODSThis population‐based study included 5432 participants (age ≥60 years); of these, plasma amyloid beta (Aβ), total tau, and neurofilament light chain (NfL) were measured in a subsample (n = 1412). We used hierarchical clustering to generate five multimorbidity clusters from 23 chronic diseases. We diagnosed dementia and MCI following international criteria. Data were analyzed using logistic and linear regression models.RESULTSThe number of chronic diseases was associated with dementia (multivariable‐adjusted odds ratio = 1.22; 95% confidence interval [CI] = 1.11 to 1.33), AD (1.13; 1.01 to 1.26), vascular dementia (VaD) (1.44; 1.25 to 1.64), and non‐amnestic MCI (1.25; 1.13 to 1.37). Metabolic cluster was associated with VaD and non‐amnestic MCI, whereas degenerative ocular cluster was associated with AD (p < 0.05). The number of chronic diseases was associated with increased plasma Aβ and NfL (p < 0.05).DISCUSSIONMultimorbidity burden and clusters are differentially associated with subtypes of dementia and MCI and AD‐related plasma biomarkers in older adults.Highlights We used hierarchical clustering to generate five clusters of multimorbidity. The presence and load of multimorbidity were associated with dementia and mild cognitive impairment. Multimorbidity clusters were differentially associated with subtypes of dementia and Alzheimer's disease plasma biomarkers.

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Global rural health disparities in Alzheimer's disease and related dementias: State of the science

Cited by 19 publications

References 254 publications

Alcohol Use Disorder and Dementia: A Review

Alcohol Use Disorder and Dementia: A Review

Association of objective sleep duration with cognition and brain aging biomarkers in older adults

Multimorbidity, cognitive phenotypes, and Alzheimer's disease plasma biomarkers in older adults: A population‐based study

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