Temporal trends in cognitive function of older US adults associated with population changes in demographic and cardiovascular profiles

Bancks, Michael P.; Alonso, Álvaro; Allen, Norrina B.; Yaffe, Kristine; Carnethon, Mercedes R.

doi:10.1136/jech-2018-211985

Cited by 12 publications

(9 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Reductions in dementia incidence over time may be because of a combination of factors. In the general population, decreasing dementia incidence has been hypothesized to be due in part to improved prevention and management of cardiovascular risk factors for dementia as well as population-level improvements in educational attainment [14,15,31]. Our observation that reductions in incident dementia were more pronounced among PWH may indicate better chronic disease management and attention to modifiable risk factors such as smoking cessation and hypertension control in this population [32,33], which typically has more frequent contact with the healthcare system than the average adult.…”

Section: Discussionmentioning

confidence: 99%

Comparison of dementia incidence and prevalence between individuals with and without HIV infection in primary care from 2000 to 2016

Lam

Lee

Gilsanz

et al. 2021

Aids

View full text Add to dashboard Cite

Methods: People with HIV (PWH) on antiretroviral therapy (ART) and demographically similar people without HIV (PWoH), all aged 50 years and older, were identified from Kaiser Permanente healthcare systems in Northern California, Southern California, and Mid-Atlantic States (Maryland, Virginia, Washington DC). Dementia diagnoses were obtained from electronic health records. Incidence and prevalence of dementia, overall and by time period (i.e. 2000-2002, 2003-2004, . . ., 2015-2016), were calculated using Poisson regression. Trends were examined using Joinpoint regression. Rate ratios were used to compare dementia by HIV status with adjustment for sociodemographics, substance use, and clinical factors. Results:The study included 13 296 PWH and 155 354 PWoH (at baseline: for both, mean age ¼ 54 years, 89% men; for PWH, 80% with HIV RNA <200 copies/ml). From 2000 to 2016, overall incidence of dementia was higher among PWH [adjusted incidence rate ratio (aIRR) ¼ 1.80, 95% confidence interval (CI) ¼ 1.60-2.04]. Dementia incidence decreased among both PWH and PWoH (À8.0 and À3.1% per period, respectively) but remained higher among PWH in the most recent time period, 2015-2016 (aIRR ¼ 1.58, 95% CI ¼ 1.18-2.12). The overall prevalence of dementia from 2000 to 2016 was higher among PWH [adjusted prevalence ratio (aPR) ¼ 1.86, 95% CI ¼ 1.70-2.04] and was also higher among PWH in 2015-2016 (aPR ¼ 1.75, 95% CI ¼ 1.56-1.97). Conclusion:Reductions in dementia incidence are encouraging and may reflect ART improvement, but PWH are still more likely to have dementia than PWoH. Monitoring the burden of dementia among PWH is important as this population ages.

show abstract

Section: Discussionmentioning

confidence: 99%

Comparison of dementia incidence and prevalence between individuals with and without HIV infection in primary care from 2000 to 2016

Lam

Lee

Gilsanz

et al. 2021

Aids

View full text Add to dashboard Cite

show abstract

“…Potential explanations are differences of educational systems. Earlier studies have demonstrated that the level of school education has long-lasting effects until old age [9,[37][38][39]. After having acknowledged the pivotal role of school systems, this should lead to efforts to ensure that all segments of the population are profiting while access to a high level of education should not be taken for granted [40,41].…”

Section: Plos Onementioning

confidence: 99%

“…Studies have consistently reported improvements of measured intelligence and cognitive abilities from one generation to the following one. This development became known as the "Flynn-effect" that was described in particular for Germany, France, Israel, Japan, Kenia and the Netherlands, while smaller increases were reported for Brazil, Ireland, New Zealand, Great Britain, and the USA [5][6][7][8][9]. In populations with comparably low levels of cognitive abilities, increases were particularly high, while for Norway and Sweden, stagnation at a very high level was reported.…”

Section: Introductionmentioning

confidence: 99%

Increasingly capable at the ripe old age? Cognitive abilities from 2004 to 2013 in Germany, Spain, and Sweden

et al. 2021

View full text Add to dashboard Cite

Background Life expectancy is increasing in most high-income countries, but gains in life years are maximized if spent in good health and if cognitive abilities are maintained until old age. Age-related decline of cognitive abilities does nevertheless occur, but the pace of decline is decisive. This was the starting point for our study that aims to examine cohort effects of cognitive aging in women and men in Germany, Spain and Sweden by analyzing changes from 2004 to 2013 by estimating cohort effects within age groups starting from the age of 50 years. Methods A cohort study was conducted that was based on data of the surveys 2004 (N = 6,081) and 2013 (N = 8,650) from the Survey of Health, Ageing and Retirement in Europe (SHARE). The analyses were based on data of female and male respondents aged 50 years and older. Age-specific means of verbal fluency and delayed recall from the German, Spanish and Swedish samples were the cognitive domains considered in the study. Results In both domains of cognitive ability the achievements in the later surveys were higher than in the earlier ones. This was found in all countries, abut achievement levels increased markedly in the German and the Spanish samples, while the scores of the Swedish samples were not significantly different. While the highest scores were found for Sweden, Germany ranked in the middle and the lowest scores were found in the Spanish samples. Over time, the scores of the German samples approached those of Sweden. Conclusions From the first to the second survey, improvements of older adults’ cognitive abilities were found for all countries considered. This may indicate improvements of the underlying educational systems, but also increasingly stimulating general living conditions.

show abstract

“…40 Interestingly, these declines in dementia incidence coincide with improvements in education but also with advances in cardiovascular treatment including medications, public awareness, and stricter treatment guidelines. 41–43 Cumulatively, these data provide compelling evidence to support clinical trials of vascular risk factor treatment to prevent or delay cognitive decline and dementia.…”

mentioning

confidence: 93%

Trials and Treatments for Vascular Brain Health: Risk Factor Modification and Cognitive Outcomes

Kivipelto

Palmer

Hoang

et al. 2022

Stroke

Self Cite

View full text Add to dashboard Cite

There is robust evidence linking vascular health to brain health, cognition, and dementia. In this article, we present evidence from trials of vascular risk factor treatment on cognitive outcomes. We summarize findings from randomized controlled trials of antihypertensives, lipid-lowering medications, diabetes treatments (including antidiabetic drugs versus placebo, and intensive versus standard glycemic control), and multidomain interventions (that target several domains simultaneously such as control of vascular and metabolic factors, nutrition, physical activity, and cognitive stimulation etc). We report that evidence on the efficacy of vascular risk reduction interventions is promising, but not yet conclusive, and several methodological limitations hamper interpretation. Evidence mainly comes from high-income countries and, as cognition and dementia have not been the primary outcomes of many trials, evaluation of cognitive changes have often been limited. As the cognitive aging process occurs over decades, it is unclear whether treatment during the late-life window is optimal for dementia prevention, yet older individuals have been the target of most trials thus far. Further, many trials have not been powered to explore interactions with modifiers such as age, race, and apolipoprotein E, even though sub-analyses from some trials indicate that the success of interventions differs depending on patient characteristics. Due to the complex multifactorial etiology of dementia, and variations in risk factors between individuals, multidomain interventions targeting several risk factors and mechanisms are likely to be needed and the long-term sustainability of preventive interventions will require personalized approaches that could be facilitated by digital health tools. This is especially relevant during the coronavirus disease 2019 (COVID-19) pandemic, where intervention strategies will need to be adapted to the new normal, when face-to-face engagement with participants is limited and public health measures may create changes in lifestyle that affect individuals’ vascular risk profiles and subsequent risk of cognitive decline.

show abstract

Temporal trends in cognitive function of older US adults associated with population changes in demographic and cardiovascular profiles

Cited by 12 publications

References 25 publications

Comparison of dementia incidence and prevalence between individuals with and without HIV infection in primary care from 2000 to 2016

Comparison of dementia incidence and prevalence between individuals with and without HIV infection in primary care from 2000 to 2016

Increasingly capable at the ripe old age? Cognitive abilities from 2004 to 2013 in Germany, Spain, and Sweden

Trials and Treatments for Vascular Brain Health: Risk Factor Modification and Cognitive Outcomes

Contact Info

Product

Resources

About