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Cornett, Patricia F. "Risk Factors for Vascular Dementia." Thesis, University of North Texas, 2005. https://digital.library.unt.edu/ark:/67531/metadc4781/.
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Dementia is a devastating disorder that commonly affects people over the age of 65. Alzheimer's disease and vascular dementia are the most common forms of dementias. A number of studies have implicated cardiovascular risks as important factors in the development of dementia. These risks include high-risk behaviors such as smoking and risks related at least partially to health behaviors such as diet and exercise. This study examines a group of cardiovascular risk factors, as defined by the Framingham study, to ascertain if they are predictors of dementia. A retrospective chart review of 481consecutive patients seen in a geriatric medicine clinic produced a sample of 177 individuals diagnosed with dementia and 304 individuals without a dementia diagnosis. Relative risk ratio (RRR) results indicate that a history of hypertension (RRR= 1.80, p = .009) and a history of hypercholesterolemia (RRR = 1.85, p = .016) are significant predictors of Alzheimer's disease. A history of tobacco use (RRR = 2.18, p = .01) is a significant predictor of vascular dementia. Stepwise regression analyses indicate that hypercholesterolemia is an independent predictor of dementia (b = -.113, p = .009) and hypercholesterolemia (b = -.104, p = .018) and hypertension (b = -.094, p = .031) clustered together have an additive risk factor effect. These results are discussed in terms of the importance of specific health behaviors in the development and possible prevention of dementia.
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Mawanda, Francis. "Emerging risk factors for dementia: associations between clinical infections, PTSD, psychotropic PTSD medication use, and the risk for dementia." Diss., University of Iowa, 2015. https://ir.uiowa.edu/etd/2117.
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Dementia is a major public health problem worldwide. Emerging research indicates that clinical infections and PTSD could be important risk factors for dementia. However, evidence for infections and the risk of dementia primarily examines central nervous system (CNS) infections. Extant epidemiological evidence for systemic bacterial infections and the risk for dementia is limited while that for PTSD and the risk for dementia did not account for psychotropic medications commonly used in management of PTSD and could affect cognitive function. The purpose of this study was to 1) review the evidence for CNS infections as possible causes of Alzheimer’s disease (AD) dementia, and 2) using nationwide Veterans Health Administration databases, conduct original retrospective cohort analyses in nationally representative samples of U.S. veterans aged 56 years and older to determine the associations between systemic bacterial infections, PTSD, and psychotropic PTSD medication use with the risk for developing dementia.
Review of the research pertaining to an infectious AD etiology hypothesis including the various mechanisms through which different clinical and subclinical infections could cause or promote the progression of AD, and the concordance between putative infectious agents and the epidemiology of AD showed evidence linking AD to an infectious cause to be largely inconclusive; however, the amount of evidence suggestive of an association is too substantial to ignore.
Analysis of the associations between systemic bacterial infections and the risk for dementia showed a significant association between exposure to any systemic bacterial infection and an increased risk for dementia (hazard ratio [HR] = 1.20; 95% confidence interval [CI] = 1.16-1.24) after adjustment for demographic characteristics, and medical and psychiatric comorbidity. In addition, septicemia (HR=1.39; 95%CI=1.16-1.66), bacteremia (HR=1.22; 95%CI=1.0-1.49), osteomyelitis (HR=1.20; 95%CI=1.06-1.37), pneumonia (HR=1.10; 95%CI=1.02-1.19), UTI (HR=1.13; 95%CI=1.08-1.18), and cellulitis (HR=1.14; 95%CI=1.09-1.20) were independently associated with significantly increased risk of developing dementia after adjustment for potential confounders.
Analysis of the associations between PTSD and psychotropic PTSD medication use with the risk for dementia showed a significant association between PTSD and the risk for dementia (HR=1.35; 95%CI=1.27-1.43) after adjustment for demographic characteristics, medical and psychiatric comorbidity, and health care utilization. Analysis of the impact of psychotropic PTSD medications including selective serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors (SNRI), benzodiazepines (BZA), novel antidepressants (NA) and atypical antipsychotics (AA) on the association between PTSD and the risk for dementia showed significant interactions between PTSD and use of SSRIs (p<.0001), NAs (p=.0016), and AAs (p<.0001). Multivariate analysis showed a significant association between PTSD and an increased risk for dementia among individuals not using any psychotropic PTSD medications at baseline (HR=1.70; 95%CI=1.58-1.82). PTSD patients using SSRIs (HR=2.10; 95%CI=1.82-2.41), NAs (2.19; 95%CI=1.94-2.48) or AAs (4.56; 95%CI=4.04-5.15) were significantly more likely to develop dementia compared to those without PTSD and not using any psychotropic PTSD medications. PTSD patients using SSRIs (HR=1.24; 95%CI=1.08-1.42), NAs (HR=1.29; 95% CI=1.14-1.46) or AAs (HR=2.69; 95%CI=2.38-3.04) were also significantly more likely to develop dementia compared to those with PTSD and not using any psychotropic PTSD medications. SNRI (HR=1.35; 95%CI=1.26-1.46) and BZA drug use (HR=1.40; 95%CI=1.35-1.45) at baseline was associated with an increased risk for dementia regardless of PTSD diagnosis.
These findings indicate; 1) evidence for an infectious AD etiology hypothesis in inconclusive, 2) both severe (e.g. sepsis), and less severe (e.g. cellulitis) systemic bacterial infections are collectively and independently associated with an increased risk of dementia among older U.S. veterans hence prevention of systemic bacterial infections could positively influence the risk for dementia among older adults, and 3) PTSD and psychotropic medication use are associated with an increased risk for dementia among U.S. veterans.
Further epidemiologic, clinical, and basic science research is required to elucidate the mechanisms and the associations between infections and the risk for dementia and to determine if the independent and effect modifying impacts of psychotropic PTSD medication use on the risk for dementia are related to differences in PTSD severity, other psychiatric comorbidity, or whether psychotropic PTSD medication use is an independent risk factor for dementia.
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Jong, F. J. de. "Endocrine factors, retinal vessels, and risk of dementia." [S.l.] : Rotterdam : [The Author] ; Erasmus University [Host], 2007. http://hdl.handle.net/1765/13953.
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Podewils, Laura Jean. "Physical activity and dementia risk a prospective study /." Available to US Hopkins community, 2003. http://wwwlib.umi.com/dissertations/dlnow/3080747.
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Billioti, de Gage Sophie. "Benzodiazepines and risk of dementia in the elderly." Thesis, Bordeaux, 2015. http://www.theses.fr/2015BORD0106/document.
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Ce travail porte sur l’étude du risque de démence chez les personnes âgées ayant consommé des benzodiazépines. Ces médicaments méritent une attention particulière du fait de (i) leur utilisation trop systématique et le plus souvent chronique contrairement aux recommandations préconisant des durées d’utilisation courtes (ii) leurs effets délétères sur la cognition demeurant mal évalués à long terme. La plupart des études conduites sur ce sujet ont conclu à une augmentation du risque de démence chez les sujets ayant utilisé des benzodiazépines. Un biais protopathique pouvait cependant, en partie du moins, avoir expliqué ces résultats : la prescription de benzodiazépines pouvait avoir été motivée par des prodromes souvent observés au cours des années précédant le diagnostic de la maladie. Afin de mieux prendre en considération ce biais, le projet BENZODEM a utilisé les ressources de la cohorte PAQUID (3777 sujets ≥ 65 ans tirés au sort sur les listes électorales de Dordogne et Gironde bénéficiant d’un suivi de plus de 20 ans). Ce projet, combinant deux études de cohorte et une étude cas-‐témoins, a conclu à un risque de démence augmenté de 46 à 62% chez les utilisateurs de benzodiazépines et retardé de 5 à 15 ans par rapport à l’initiation du traitement. La seconde partie du programme (BENZODEM2) a consisté en une étude cas-‐témoins conduite sur un large échantillon de sujets de plus de 65 ans enregistrés sur la base de données de la Régie de l’Assurance Maladie du Québec (RAMQ). Ce programme a permis (1) de valider les précédents résultats (risque augmenté de 30 à 80% en fonction de la dose, la durée du traitement et la nature des molécules) (2) d’identifier les profils de consommation associés à un excès de risque : consommateurs de plus de 3 mois avec une relation dose-‐effet marquée et molécules à longue demi-‐ vie d’élimination. Des explorations complémentaires ont permis de conclure que cet excès de risque n’était pas expliqué par une mortalité différentielle entre groupes comparés ni par la prescription d’autres médicaments psychotropes. Une autre étude menée sur PAQUID montrait une absence de différence entre consommateurs et non consommateurs de benzodiazépines vis-‐à-‐vis de l’évolution des scores mesurant les fonctions cognitives. Ces résultats ont permis d’émettre des hypothèses concernant le mécanisme de l’association entre utilisation de benzodiazépines et démence: (1) les benzodiazépines pourraient constituer des marqueurs précoces de la maladie ; (2) les benzodiazépines pourraient aussi diminuer les capacités de recours à la réserve cognitive en réponses aux lésions précoces de la maladie au stade préclinique ; (3) il est aussi possible que ces deux explications soient combinéesThis work deals with the risk of dementia in elderly individuals who have used benzodiazepines. These drugs deserve particular attention because (i) their use appears to be too systematic and most often chronic despite good practice guidelines recommending short durations of use (ii) their deleterious effects on cognition remain underevaluated for the long-‐term. Most of the studies conducted concluded that there was an increased risk of dementia among benzodiazepine users. In fact, a protopathic bias could, at least in part, have explained these results. Indeed, the prescription of benzodiazepines could have been motivated by the prodromes often observed several years before the clinical diagnosis of a dementia. With the aim of better controlling for this bias, the BENZODEM project used the resources of the PAQUID cohort (3777 subjects ≥65 years randomly sampled from electoral lists in South-‐West France, with a 20-‐ year follow-‐up). This project combined two cohort studies and one case-‐control. These studies concluded in a risk of dementia increased by 46 to 62% in benzodiazepine users and delayed by 5 to 15 years after treatment initiation. The second part of the programme (BENZODEM2) consisted of a case-‐control study conducted in a large sample of subjects >65 years registered in the Quebec Health care database (Régie de l’Assurance Maladie du Québec, RAMQ). It was thus possible(1) to validate the previous results by using a different population (the risk was found to be increased by 30 to 80% depending on the patterns of use regarding dose, duration and type of molecule), (2) to identify the patterns of use which appeared to be at risk; excess risk was only apparent for uses of more than three months with a marked dose-‐effect relationship, and was higher for molecules with a long elimination half-‐life. Complementary explorations using the PAQUID cohort indicated that the excess risk in exposed was not explained by a differential mortality rate between the groups compared. Other studies suggested that the link found remained independently of the prescription of other psychotropics. Another analysis in the PAQUID cohort showed that, in the absence of dementia, no difference was observed between benzodiazepine users and non-‐users with regards to the evolution of scores evaluating cognitive functions. These results led to several assumptions about the putative mechanism explaining the relationship found between benzodiazepine use and dementia: (1) benzodiazepines could be early markers of symptoms such as anxiety, depression or insomnia, which are potential prodromes or risk factors for this disease, (2) these drugs could also reduce the ability to use cognitive reserve in order to cope with early lesions of the disease during the preclinical stage, (3) the association found could also result from these two mechanisms
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Eriksson, Ulrika K. "Inflammation-associated risk factors for Alzheimer's disease and dementia." Stockholm, 2010. http://diss.kib.ki.se/2010/978-91-7409-802-0/.
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Liolitsa, Danae. "Genetic risk factors in Alzheiner's disease : a hypothesis-based candidate gene approach." Thesis, King's College London (University of London), 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.252104.
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Rönnemaa, Elina. "Predictors of Dementia : Insulin, Fatty Acids and Vascular Risk Factors." Doctoral thesis, Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-164528.
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Identification of modifiable risk factors for Alzheimer’s disease (AD) is crucial in order to diminish suffering from this devastating disease. The aim of this thesis was to investigate if different aspects of glucose metabolism, insulin, fatty-acid composition or other vascular risk factors predict the future development of AD and dementia. This thesis is based on the Uppsala Longitudinal Study of Adult Men (ULSAM) cohort, which started in 1970. A total of 2322 men at age 50 were examined with focus on vascular risk factors. The cohort was re-examined at ages 60, 71, 77, 82 and 88. Incident diagnoses of AD, vascular dementia, other dementias and cognitive impairment were assessed in 2005–2010. The risk of AD was increased in subjects with lower early insulin response measured with both an intravenous glucose tolerance test at 50 years and an oral glucose tolerance test at 71 years of age. The presence of vascular risk factors such as hypertension, obesity, hypercholesterolemia and smoking increased the risk of future vascular dementia but not of AD. Furthermore, saturated fatty acids at midlife were inversely associated with risk of AD. No evidence of a protective effect of omega-3 fatty acids against dementia was found. The susceptibility allele, APOE ε4, was the strongest individual risk factor. APOE ε4 carriers with vascular risk factors had the greatest risk of developing dementia. Low insulin response was a risk factor for AD mainly in APOE ε4 non-carriers. Disturbances in insulin and glucose metabolism, vascular risk factors and fatty acids are linked differentially to the pathogenesis of AD and vascular dementia. These observations should be considered when future clinical approaches are planned to prevent and postpone the onset of dementia.ULSAM
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Ding, Xiuhua. "MODELING DEMENTIA RISK, COGNITIVE CHANGE, PREDICTIVE RULES IN LONGITUDINAL STUDIES." UKnowledge, 2016. http://uknowledge.uky.edu/epb_etds/9.
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Dementia is increasing recognized as a major problem to public health worldwide. Prevention and treatment strategies are in critical need. Nowadays, research for dementia usually featured as complex longitudinal studies, which provide extensive information and also propose challenge to statistical methodology. The purpose of this dissertation research was to apply statistical methodology in the field of dementia to strengthen the understanding of dementia from three perspectives: 1) Application of statistical methodology to investigate the association between potential risk factors and incident dementia. 2) Application of statistical methodology to analyze changes over time, or trajectory, in cognitive tests and symptoms. 3) Application of statistical learning methods to predict development of dementia in the future.
Prevention of Alzheimer’s disease with Vitamin E and Selenium (PREADViSE) (7547 subjects included) and Alzheimer’s disease Neuroimaging Initiative (ADNI) (591 participants included) were used in this dissertation. The first study, “Self-reported sleep apnea and dementia risk: Findings from the PREADViSE Alzheimer’s disease prevention trial ”, shows that self-reported baseline history of sleep apnea was borderline significantly associated with risk of dementia after adjustment for confounding. Stratified analysis by APOE ε4 carrier status showed that baseline history of sleep apnea was associated with significantly increased risk of dementia in APOE ε4 non-carriers. The second study, “comparison of trajectories of episodic memory for over 10 years between baseline normal and MCI ADNI subjects,” shows that estimated 30% normal subjects at baseline assigned to group 3 and 6 stay stable for over 9 years, and normal subjects at baseline assigned to Group 1 (18.18%) and Group 5 (16.67%) were more likely to develop into dementia. In contrast to groups identified for normal subjects, all trajectory groups for MCI subjects at baseline showed the tendency to decline. The third study, “comparison between neural network and logistic regression in PREADViSE trial,” demonstrates that neural network has slightly better predictive performance than logistic regression, and also it can reveal complex relationships among covariates. In third study, the effect of years of education on response variable depends on years of age, status of APOE ɛ4 allele and memory change.
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De, Ronchi Diana. "Education and dementing disorders : the role of schooling in dementia and cognitive impairment /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-349-3/.
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O'Donovan, Simon Terence. "Dementia caregiving : burden and breakdown." Thesis, University of South Wales, 2004. https://pure.southwales.ac.uk/en/studentthesis/dementia-caregiving(34088905-f406-4d82-bc09-aeed052f5e3c).html.
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This study was an investigation of the phenomenon of dementia caregiving burden and breakdown in community caregiving situations. 109 carer subjects participated in the study, with 91 current carers - 17 via face-to-face interview and 74 via the internet, and 18 past carers - two via face-to-face interview and 16 via the internet, contributing their experiences of dementia caregiving. Two new carers' assessment tools were devised to meet more fully the requirements of the 'Carers (Recognition and Services) Act 1995' (DoH, 1995), namely the 'Dementia Caregiving Problems Questionnaire (DCPQ)' and 'Dementia Caregiving Burden Questionnaire (DCBQ)'. These new assessments were tested and demonstrated to be reliable, with Cronbach Alpha scores of 0.7029 and 0.8430 respectively, and are recommended for implementation in clinical practice. The key predictive risk factors for high caregiving burden in this study were perceived stress; omission of caregiving satisfactions; carer depression; perceived impact on quality of life; perceived helpfulness of community care services; behaviour problems - especially shouting, swearing and screaming, irritability and night disturbance; poor quality carer/dependant relationship; mood problems; perceived helpfulness of informal support; perceived impact of caregiving on dependant emotional well-being and, to a lesser extent, hours spent in caregiving. The key predictive risk factors for expected relinquishment of home caregiving were DCBQ score; perceived impact on quality of life; perceived stress; carer depression and, to a lesser extent, geographical distance in caregiving; perceived helpfulness of community care services and omission of positive feelings in the carer. Based on the above risk factors, a new 'Dementia Caregiving Breakdown Risk Assessment Tool (DCBRAT)' is proposed for use by community care managers to identify 'at risk' caregiving situations so that service interventions can be targetted more towards carers who are highly burdened in their role, who are at risk of developing psychological health problems or who may be nearing breakdown in their caregiving situation. Thus the effectiveness of service interventions may be maximised and optimal health gain for carers achieved, resulting in improved outcomes for people with dementia. The DCBRAT and the similarly proposed 'Conceptual Model of Dementia Caregiving, Burden and Breakdown' will need to be further tested in post-doctoral research.
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Guedes, Sandra Daniela Silva. "Testing a dementia risk group for polymorphisms in inflammation-related genes." Master's thesis, Universidade de Aveiro, 2016. http://hdl.handle.net/10773/18512.
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Mestrado em Biomedicina MolecularA doença de Alzheimer (AD) é uma perturbação degenerativa multifatorial associada com a idade que ocorre no sistema nervoso central. Após a sua descrição inicial em 1907, numerosas teorias foram propostas para elucidar quais as principais causas associadas. A hipótese da inflamação tem sido recentemente reconhecida pela comunidade científica, uma vez que muitos estudos em modelos e doentes de Alzheimer propuseram fortes evidências da ativação do sistema imunológico e de processos inflamatórios durante o curso da doença. De facto, a acumulação de β-amilóide (Aβ) e proteína tau provocam uma resposta inflamatória cerebral como resultado do desenvolvimento patológico da AD. Atualmente, os estudos de associação genómica genética (GWAS) proporcionaram a identificação de diversas variantes genéticas que influenciam por exemplo processos inflamatórios e as vias do sistema imunitário na AD, estando as regiões polimórficas CLU rs11136000 e CR1 rs3818361 entre elas. Além disso, ambos os polimorfismos de um único nucleótido (SNPs) parecem ter um papel colaborativo relativamente à eliminação de Aβ e à ativação do sistema imunitário através da estimulação do complemento. No trabalho aqui descrito, foram realizadas análises bioinformáticas de genes de risco para a AD, principalmente o CLU e o CR1. As informações obtidas foram usadas para criar uma rede de interação proteína-proteína, bem como para realizar análises de enriquecimento de Ontologia Genética. A nossa análise bioinformática indica que ambos os genes CLU e CR1 estão envolvidos numa variedade de vias de sinalização que compreendem a regulação do processo inflamatório e ativação do sistema imunológico. A expressão genética de cada alelo de risco das SNPs CLU rs11136000 e CR1 rs3818361 foi ainda avaliada em amostras de doentes “Putativos AD” e Controlos por testes de PCR e análises de sequenciação de Sanger. Adicionalmente, as frequências genotípicas e alélicas também foram determinadas com o intuito de criar um perfil genético dos grupos estudados. Os nossos resultados demostraram que no grupo de doentes “Putativos AD” analisado para a variante CLU rs11136000, o alelo de risco C apresentou maior frequência (64%) quando comparado com o grupo Controlos (40%). O grupo de Controlos apresentou uma frequência de 60% para o alelo de não-risco. Para a variante CR1 rs3818361, o alelo de risco A apresentou frequências semelhantes entre grupos, apesar do aumento da percentagem de homozigóticos de risco (6%) no grupo de doentes “Putativos AD”. Este trabalho auxilia na compreensão da relação entre estes polimorfismos genéticos e demência. Estudos adicionais devem avaliar o uso destas SNPs como ferramentas potencialmente úteis no diagnóstico da AD.
Alzheimer’s disease (AD) is a multifactorial age associated degenerative disorder that occurs in the central nervous system. After its initial report in 1907, numerous theories have been proposed to elucidate on what are the related main causes. The inflammation hypothesis has been recently acknowledged by the scientific community since several studies in AD models and patients strongly supported the activation of the immune system and of inflammatory processes during disease development. In fact, the accumulation of amyloid-β (Aβ) and tau-neurofibrillary tangles provokes a brain inflammatory response as a consequence of the pathological development of AD. Currently, genome-wide association studies (GWAS) have provided several genetic variants that impact inflammation and immune system pathways in AD, being the polymorphic regions CLU rs11136000 and CR1 rs3818361 among them. Furthermore, both single-nucleotide polymorphisms (SNPs) appear to have a collaborative role regarding Aβ clearance and immune system activation via complement stimulation. In the work here described, bioinformatics analyses of AD risk-related genes, focusing on CLU and CR1 were performed and the retrieved information used to rise a protein-protein interaction network, as well as to perform Gene Ontology enrichment analyses. Our bioinformatics analysis indicates that CLU and CR1 are involved in a variety of signaling pathways that comprise activation and regulation of immune system process. CLU rs11136000 and CR1 rs3818361 genetic expression of each SNP risk allele was further evaluated in whole blood samples from “Putative AD” and Controls groups by PCR assays and Sanger sequencing analyses. Additionally, the genotyping and allelic frequencies were also determined in order to create a genetic profile of the studied groups. Our results showed that on the “Putative AD” group analyzed for CLU rs11136000 variant, the C-risk allele presented a higher frequency (64%) when compared to Controls (40%). The Controls group displayed a 60% frequency for the non-risk allele. For the CR1 rs3818361 variant, the A-risk allele showed similar frequencies among groups, although an increase in the percentage of homozygous risk carriers (6%) was observed in the “Putative AD” group. This work aids into the understanding of the relation between these genetic polymorphisms and dementia. Additional studies should address the use of these SNPs as potential tools in AD diagnostics.
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Duan, Ran. "EVALUATING THE IMPACTS OF ANTIDEPRESSANT USE ON THE RISK OF DEMENTIA." UKnowledge, 2019. https://uknowledge.uky.edu/epb_etds/23.
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Dementia is a clinical syndrome caused by neurodegeneration or cerebrovascular injury. Patients with dementia suffer from deterioration in memory, thinking, behavior and the ability to perform everyday activities. Since there are no cures or disease-modifying therapies for dementia, there is much interest in identifying modifiable risk factors that may help prevent or slow the progression of cognitive decline. Medications are a common focus of this type of research.
Importantly, according to a report from the Centers for Disease Control and Prevention (CDC), 19.1% of the population aged 60 and over report taking antidepressants during 2011-2014, and this number tends to increase. However, antidepressant use among the elderly may be concerning because of the potentially harmful effects on cognition. To assess the impacts of antidepressants on the risk of dementia, we conducted three consecutive projects.
In the first project, a retrospective cohort study using Marginal Structural Cox Proportional Hazards regression model with Inverse Probability Weighting (IPW) was conducted to evaluate the average causal effects of different classes of antidepressant on the risk of dementia. Potential causal effects of selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), atypical anti-depressants (AAs) and tri-cyclic antidepressants (TCAs) on the risk of dementia were observed at the 0.05 significance level. Multiple sensitivity analyses supported these findings.
Unmeasured confounding is a threat to the validity of causal inference methods. In evaluating the effects of antidepressants, it is important to consider how common comorbidities of depression, such as sleep disorders, may affect both the exposure to anti-depressants and the onset of cognitive impairment. In this dissertation, sleep apnea and rapid-eye-movement behavior disorder (RBD) were unmeasured and thus uncontrolled confounders for the association between antidepressant use and the risk of dementia. In the second project, a bias factor formula for two binary unmeasured confounders was derived in order to account for these variables. Monte Carlo analysis was implemented to estimate the distribution of the bias factor for each class of antidepressant. The effects of antidepressants on the risk of dementia adjusted for both measured and unmeasured confounders were estimated. Sleep apnea and RBD attenuated the effect estimates for SSRI, SNRI and AA on the risk of dementia.
In the third project, to account for potential time-varying confounding and observed time-varying treatment, a multi-state Markov chain with three transient states (normal cognition, mild cognitive impairment (MCI), and impaired but not MCI) and two absorbing states (dementia and death) was performed to estimate the probabilities of moving between finite and mutually exclusive cognitive state. This analysis also allowed participants to recover from mild impairments (i.e., mild cognitive impairment, impaired but not MCI) to normal cognition, and accounted for the competing risk of death prior to dementia. These findings supported the results of the main analysis in the first project.
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Alford, Susan Elizabeth. "A Predictive Model for Dementia Risk in Elderly Adults with Prediabetes." ScholarWorks, 2014. https://scholarworks.waldenu.edu/dissertations/129.
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Dementia is a serious public health concern in the United States, with a prevalence of 5.2 million. There is currently no effective way to prevent or cure dementia, and the precise etiology is unknown, but it appears there are multiple risk factors. Prediabetes (PD) has been identified as a risk factor although the scientific evidence is conflicting. This study is important to those at high risk for dementia and to healthcare professionals who lack substantiated dementia prevention strategies. The purpose of this case control study was to determine whether PD is associated with dementia in adults aged 65-95 years and whether the association varies according to demographic (age, gender, race, and socioeconomic status [SES]) and health (atherosclerosis, body weight, cerebrovascular disease, dyslipidemia, hypertension, and stroke) risk factors. The ecosocial theory was selected to bridge the study findings to life-course exposures and risk factors. Cases (n = 574) and controls (n = 2,157) were sampled from a large ambulatory care dataset, and multivariable logistic regression was used to test the research hypotheses. No unadjusted association between PD and dementia was found (OR 1.08, 95% CI = .854, 1.241, p = .604). The regression analysis revealed no association between PD and dementia; however, atherosclerosis, hypertension, low body weight, and low/average SES were found to be significantly and independently associated with dementia. A stratified analysis revealed that race and SES did not alter the effect of PD on dementia. The implications for positive social change include the potential reduction of incident dementia through initiatives targeted toward demographic and health risk factors including atherosclerosis, hypertension, low body weight, and low/average SES.
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Russ, Thomas Charles. "Integrated investigation of dementia risk factors : insights from geography, record linkage, and individual participant meta-analysis." Thesis, University of Edinburgh, 2013. http://hdl.handle.net/1842/8823.
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Dementia is a public health priority and its importance is projected to increase in coming decades, particularly in low-to middle-income countries. A description of the methodological challenges of observational studies and the limitations of previous attempts to combine the published literature leads me to discuss ascertainment of dementia cases and the suitability of dementia mortality as an outcome. I report the findings of a memory clinic study where 71.5% of 502 deceased individuals with probable Alzheimer dementia had dementia correctly recorded on their death certificate, which is an improvement on similar results from two decades earlier. I review the evidence for geographical variation in dementia and discuss the implication that such variation might point towards potentially modifiable risk or protective factors for dementia. I have attempted to overcome the methodological challenges alluded to above by only examining within-study comparisons. A metaanalysis of rural-urban comparisons reveals some evidence of increased prevalence (odds ratio; 90% confidence interval (CI): 1.11; 0.79, 1.57) and incidence (1.20; 0.84, 1.71) of dementia in rural areas. These associations were stronger for Alzheimer dementia and particularly so in studies which identified early life rural residence (prevalence 2.22; 1.19, 4.16; incidence 1.64; 1.08, 2.50). Since there are no effective treatments, there is an obvious need to focus on prevention and an urgent need to improve our understanding of the aetiology of dementia in order to attempt to prevent or delay its onset. However, it is clear that prevention must begin sufficiently early in life to have an effect – intervening in later life might be too late. I describe a body of work using the Health Survey for England cohort studies examining the association between a series of risk factors and later dementiarelated death, including cardiovascular disease risk factors, psychological distress, and socioeconomic status. For example, there is a dose-response relationship between increasing psychological distress and dementia death (12-item General Health Questionnaire score 1-3 vs 0 age- and sex-adjusted hazard ratio; 95% CI: 1.44; 1.17, 1.78; score 4-12 vs 0: 1.74; 1.36, 2.22). I conclude by summarising the contribution these publications have made to the field of dementia epidemiology and by outlining ongoing and future projects building on the work presented in this thesis.
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Garcia, Esparcia Paula. "Identification of a risk transcriptome and proteome in Parkinson’s disease, Dementia with Lewy bodies and rapidly progressive Dementia with Lewy bodies." Doctoral thesis, Universitat de Barcelona, 2016. http://hdl.handle.net/10803/664642.
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Parkinson's disease (PD) is a neurodegenerative disorder characterized by movement impairment, or parkinsonism, for which there is still no cure. The manifest clinical signs result from neuronal loss of more than 60% in the substantia nigra pars compacta. Cognitive disorders and dementia in PD usually occur, thus leading to Parkinson disease with dementia (PDD). Moreover, Dementia with Lewy bodies (DLB) is also considered a neurodegenerative disease and one of the most common causes of dementia, with cognitive impairment symptoms similar to Alzheimer-type dementia, and with parkinsonism. Its onset is insidious and is characterized by a slow progression in comparison with its fast form, also known as Dementia with Lewy bodies rapidly progressive (rpDCL), which appears suddenly and progresses quickly. In these pathologies there occurs a neural degeneration not only related to the accumulation of altered proteins, but more likely as a result of multiple deleterious factors. The hypothesis of this work is that the identification of molecular changes analyzed through the application of "-omics" techniques will be useful to obtain information about a risk transcriptome/proteome in the aforementioned diseases. Thus, the main objective of the present thesis is the identification of molecular alterations underlying functional cerebral changes and anatomical modifications in different brain regions and different Braak stages of PD, as well as DCL and DCLrp, with the use of post-mortem human brain samples compared with controls, combining microarray, mRNA, protein and enzyme assays studies. The obtained results have identified molecular alterations in PD, DLB, and rpDLB of different metabolic pathways including changes in the machinery of protein synthesis, in the mitochondrial energy metabolism, in neuroinflammation, in the purine pathway, and in new signaling pathways comprising olfactory and taste receptors paths.La enfermedad de Parkinson (EP) es una patología neurodegenerativa perteneciente al grupo de afecciones conocidas como trastornos del movimiento, o parkinsonismo, para la cual actualmente no existe cura. Los signos clínicos que manifiesta son resultado de una pérdida neuronal superior al 60% en el área cerebral más afectada, la sustancia nigra pars compacta. Asimismo, la aparición de demencia y los desórdenes cognitivos en la EP conducen a una EP con demencia. A su vez, la Demencia con cuerpos de Lewy (DCL) es también una enfermedad neurodegenerativa considerada como una de las causas más comunes de demencia, con una sintomatología de deterioro cognitivo similar a la observable en la demencia de tipo Alzheimer y con la aparición de síntomas de parkinsonismo. Su aparición es insidiosa y se caracteriza por presentar una progresión lenta, a diferencia de su forma rápida también conocida como Demencia con cuerpos de Lewy rápidamente progresiva (DCLrp), que aparece de forma súbita y evoluciona vertiginosamente. En todas estas enfermedades se produce una degeneración neural debida no únicamente a la acumulación de proteínas alteradas, sino más probablemente consecuencia de múltiples factores deletéreos convergentes. La hipótesis de este trabajo es considerar que la identificación de cambios moleculares analizados gracias a la aplicación de métodos “-ómicos” servirá para obtener información sobre un trascriptoma/proteoma de riesgo en las anteriormente citadas enfermedades. El principal objetivo abordado en la presente tesis es la identificación de las alteraciones moleculares subyacentes a los cambios cerebrales funcionales y anatómicos presentes en diferentes regiones cerebrales y en distintos estadiajes de Braak de la EP, así como en la DCL y en la DCLrp, por medio del uso de muestras de cerebro humano post-mortem comparando con controles, combinando estudios de microarrays, mRNA, proteínas y ensayos enzimáticos. Los resultados obtenidos por medio de métodos de transcriptómica con su posterior validación y ampliación a proteómica han permitido identificar alteraciones moleculares en la EP, DCL y DCLrp de distintas vías metabólicas incluyendo cambios en la maquinaria de síntesis de proteínas, en el metabolismo mitocondrial y energético, en la neuroinflamación, en la vía de las purinas y en nuevas vías de señalización comprendiendo las vías de receptores olfatorios y gustativos.
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Porcellini, Elisa <1978>. "Genetic and environmental factors associated with the risk of cognitive decline and dementia." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2011. http://amsdottorato.unibo.it/3336/.
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AD is the most common age related neurodegenerative disease in the industrialized world. Clinically AD is defined as a progressing decline of cognitive functions. Neuropathologically, AD is characterized by the aggregation of b-amyloid (Ab) peptide in the form of extracellular senile plaques, and hyperphosphorlylated tau protein in the form of intracellular neurofibrillary tangles. These neuropathological hallmarks are often accompanied by abundant microvascular damage and pronounced inflammation of the affected brain regions. In this thesis we investigated several aspects of AD focusing on the genetic aspect. We confirmed that Alpha 1 antichymotrypsin (ACT), an acute phase protein, was associated to AD subjects, being plasma levels higher in AD cases than controls. In addition, in a GWA study we demonstrated that two different gene, Clusterin and CR1 were strongly associated to AD. A single gene association not explain such a complex disease like AD. The goal should be to created a network of genetic, phenotypic and clinical data associated to AD. We used a new algorithm, the ANNs, aimed to map variables and search for connectivity among variables. We found specific variables associated to AD like cholesterol levels, the presence of variation in HMGCR enzyme and the age. Other factors such as the BMI, the amount of HDL and blood folate levels were also associated with AD. Pathogen infections, above all viral infections, have been previously associated to AD. The hypothesis suggests that virus and in particular herpes virus could enter the brain when an individual becomes older, perhaps because of a decline in the immune system. Our new hypothesis is that the presence of SNPs in our GWA gene study results in a genetic signature that might affect individual brain susceptibility to infection by herpes virus family during aging.
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Yesufu, Amina. "Demographic and modifiable risk factors for age related cognitive impairment and possible dementia." Thesis, Loughborough University, 2009. https://dspace.lboro.ac.uk/2134/32641.
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A wealth of research has reported possible risk and predictive factors for dementia, the variance across populations and the possible reasons for this variance. This thesis attempts to describe demographic and modifiable risk factors for dementia, with the emphasis on the association between (phyto) estrogens and cognitive function.
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Hatch, Daniel Joseph. "The Influence of Widowhood and Sociodemographic Moderators on Dementia and Alzheimer's Disease Risk." DigitalCommons@USU, 2013. https://digitalcommons.usu.edu/etd/1473.
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Dementia and Alzheimer's disease (AD) are highly debilitating conditions that afflict millions of elderly persons. In recent decades, biological evidence has implicated chronic stress in the etiology of these conditions. As a result, the relationship between widowhood, one of the most stressful life events, and dementia and AD has also received attention. However, studies are mixed regarding this association, and few have investigated whether this relationship is moderated by the context surrounding widowhood. This study extends this literature by investigating whether widowhood increases risk for dementia and AD and whether this risk is moderated by contextual factors including age at widowhood, remarriage after widowhood, manner of death, number of dependent and adult children at the time of widowhood, gender, presence of epsilon 4 allele of apolipoprotein E (APOE), and history of depression and antidepressant use. To do this, this investigation utilized data from the Cache County Memory Study (CCMS), a large population-based epidemiological study of dementia and AD, and the Utah Population Database (UPDB), one of the world's foremost linked genealogical databases. In Cox regression analyses that modeled time to onset of dementia and AD, gender was found to moderate the relationship between incident widowhood and dementia (HR = 1.74, 95% CI: 0.97-3.10), in that widowhood trended towards decreased risk among men (HR =0.72, CI: 0.45-1.16) but increased risk among women (HR = 1.21, CI: 0.83-1.75) in stratified models. In addition, history of depression and antidepressant use moderated the association between incident widowhood and dementia (HR = 2.63, 95% CI: 1.26-5.50) and AD (HR = 1.68, 95% CI: 1.11-2.53), in that widowhood was associated with decreased risk for dementia and AD among the never depressed (HR = 0.66, CI: 0.42-1.02 and HR = 0.54, CI: 0.31-0.92, respectively), a trend towards increased risk for AD among those with a history of antidepressant use but no depression (HR = 1.80, CI: 0.86-3.75), and with increased risk for dementia and AD among those with a history of both (HR = 1.93, CI: 0.98-3.81 and HR = 1.89, CI: 0.80-4.43). These findings advance clinical and scientific knowledge concerning the effects of widowhood on risk for dementia and AD, and underscore the importance of context in understanding this relationship.
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Greene, Daylee Rose. "Relationship Between Occupational Complexity and Dementia Risk in Late Life: A Population Study." DigitalCommons@USU, 2013. https://digitalcommons.usu.edu/etd/1975.
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According to cognitive reserve theory, challenging and/or stimulating cognitive activities can build a theoretical reserve, which may lead to a delay in the clinical expression of dementia and/or Alzheimer's Disease. These cognitively stimulating activities are thought to build cognitive strategies and neural pathways that are more efficient, enabling the individual to live symptom-free for a longer period of time. One mechanism through which cognitive reserve can be built is by participating in an occupation high in cognitive complexity. When individuals hold an occupation that is high in complexity, they may build their cognitive reserve in such a manner as to reduce their risk for dementia in late life. Using extant data from an existing longitudinal, population-based study, we examined the effect of various subdomains of cognitive complexity of the longest-held job on dementia risk. In cox regression models, individuals holding agricultural occupations and occupations high in complexity of interaction with machinery, equipment, tools and inanimate objects ("Things") had an increased risk for both AD and dementia. Socioeconomic status was found to partially mediate the relationship between high Things complexity and dementia/AD risk, as well as the relationship between agricultural occupations and dementia/AD risk. While there has been some debate regarding whether results reflect a true effect of occupational complexity or simply an effect of education, results from this study indicate that both occupational complexity and education contribute unique effects to dementia/AD risk. Gender, job duration, and APOE genotype were not found to moderate any of the above associations. An understanding of how occupational complexity impacts cognitive reserve and risk for dementia/AD will enable individuals as well as clinicians to implement activities that enhance cognitive reserve and lead to a greater number of years lived symptom-free from dementia/AD.
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Eriksson, Staffan. "Falls in people with dementia." Doctoral thesis, Umeå : Univ, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1449.
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Ngandu, Tiia. "Lifestyle-related risk factors in dementia and mild cognitive impairment : a population-based study /." Stockholm : Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 2006. http://diss.kib.ki.se/2006/91-7140-744-8/.
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Dynan, Kevin B. "A study of recently proposed cardiovascular risk factors in Alzheimer's disease and vascular dementia." Thesis, Queen's University Belfast, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.322645.
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McCullagh, C. D. "An investigation of inflammatory and vascular genetic risk factors for stroke and dementia following stroke." Thesis, Queen's University Belfast, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.403191.
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Shaw, Fiona Elisabeth. "Risk modification of falls in older patients with cognitive impairment and dementia attending a casualty department." Thesis, University of Newcastle upon Tyne, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.391965.
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Severin, Kimberley. "Statins and Risk of Alzheimer Disease: A Systematic Review and Meta-Analysis." University of Cincinnati / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1352489450.
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McParland, Patricia. "Dementia : what comes to mind? : an exploration into how the general public understands and responds to dementia." Thesis, University of Stirling, 2014. http://hdl.handle.net/1893/20411.
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This thesis explores how the general public understands and responds to dementia. In the context of this study the word ‘understanding' is used to convey the complex co-construction of knowledge and establishing of beliefs that constitutes public understandings of dementia. The study also examines the responses of members of the public to dementia, in the context of their understanding. Data were collected over a 12 month period and included a module in the Northern Ireland Life and Times (NILT) survey, five focus groups and nine interviews with participants from the focus groups. The survey module included thirty measures examining levels of knowledge and attitudes towards dementia. 1200 participants were targeted and the survey was administered by the Northern Ireland Research & Statistics Agency with a response rate of 58%. The focus groups and interviews provided the mechanism to gather a more nuanced picture, exploring the beliefs behind the attitudes and the self-reported responses of participants to people with dementia. Findings indicate that the general public has a reasonable knowledge of the symptoms and pathway of dementia in line with a bio medical model. However the findings also indicate that the general public holds a mix of theoretical and empirical knowledge and that this is often contradictory. A complex mix of scientific or medical information, experience, anecdote and assumptions contribute to the discourse. This information is stored and conveyed in the form of stories and a consequence of this interplay is that individual experiences told in the form of stories are generalised to become building blocks in the construction of what the general public understands dementia to be. The current construction of dementia among the general public is found to be both nihilistic and ageist with clear evidence that dementia is stigmatised. I will argue that that the relationship between dementia and ageing in the minds of the general public is a symbiotic one. Dementia has become a cultural metaphor for unsuccessful ageing marking entry to the fourth age. The stigmatising response of the general public is the result of a complex interplay of multiple factors. I have expanded on previous ideas of multiple jeopardy and intersectionality, suggesting that the stigma associated with dementia is unique and driven as much by emotional responses as by the social location of the person with dementia. I have borrowed Brooker’s (2003) term “Dementia-ism’ to describe this stigma. This thesis argues for a more complex and sophisticated approach to changing public attitudes and reducing stigma. Dementia-ism must be addressed with the same strength of purpose currently applied to sexism, racism and ageism.
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Qian, Jing, Frank J. Wolters, Alexa Beiser, Mary Haan, M. Arfan Ikram, Jason Karlawish, Jessica B. Langbaum, et al. "APOE-related risk of mild cognitive impairment and dementia for prevention trials: An analysis of four cohorts." PUBLIC LIBRARY SCIENCE, 2017. http://hdl.handle.net/10150/623943.
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Background With the onset of prevention trials for individuals at high risk for Alzheimer disease, there is increasing need for accurate risk prediction to inform study design and enrollment, but available risk estimates are limited. We developed risk estimates for the incidence of mild cognitive impairment (MCI) or dementia among cognitively unimpaired individuals by APOE-e4 dose for the genetic disclosure process of the Alzheimer's Prevention Initiative Generation Study, a prevention trial in cognitively unimpaired APOE-e4/e4 homozygote individuals. Methods and findings We included cognitively unimpaired individuals aged 60-75 y, consistent with Generation Study eligibility criteria, from the National Alzheimer's Coordinating Center (NACC) (n = 5,073, 158 APOE-e4/e4), the Rotterdam Study (n=6,399, 156 APOE-e4/e4), the Framingham Heart Study (n = 4,078, 67 APOE-e4/e4), and the Sacramento Area Latino Study on Aging (SALSA) (n = 1,294, 11 APOE-e4/e4). We computed stratified cumulative incidence curves by age (60-64, 65-69, 70-75 y) and APOE-e4 dose, adjusting for the competing risk of mortality, and determined risk of MCI and/or dementia by genotype and baseline age. We also used subdistribution hazard regression to model relative hazard based on age, APOE genotype, sex, education, family history of dementia, vascular risk, subjective memory concerns, and baseline cognitive performance. The four cohorts varied considerably in age, education, ethnicity/race, and APOE-e4 allele frequency. Overall, cumulative incidence was uniformly higher in NACC than in the population-based cohorts. Among APOE-e4/e4 individuals, 5-y cumulative incidence was as follows: in the 60-64-y age stratum, it ranged from 0% to 5.88% in the three population-based cohorts versus 23.06% in NACC; in the 65-69-y age stratum, from 9.42% to 10.39% versus 34.62%; and in the 70-75-y age stratum, from 18.64% to 33.33% versus 38.34%. Five-year incidence of dementia was negligible except for APOE-e4/e4 individuals and those over 70 y. Lifetime incidence (to age 80-85 y) of MCI or dementia for the APOE-e4/e4 individuals in the long-term Framingham and Rotterdam cohorts was 34.69%-38.45% at age 60-64 y, 30.76%-40.26% at 65-69 y, and 33.3%-35.17% at 70-75 y. Confidence limits for these estimates are often wide, particularly for APOE-e4/e4 individuals and for the dementia outcome at 5 y. In regression models, APOE-e4 dose and age both consistently increased risk, as did lower education, subjective memory concerns, poorer baseline cognitive performance, and family history of dementia. We discuss several limitations of the study, including the small numbers of APOE-e4/e4 individuals, missing data and differential dropout, limited ethnic and racial diversity, and differences in definitions of exposure and outcome variables. Conclusions Estimates of the absolute risk of MCI or dementia, particularly over short time intervals, are sensitive to sampling and a variety of methodological factors. Nonetheless, such estimates were fairly consistent across the population-based cohorts, and lower than those from a convenience cohort and those estimated in prior studies with implications for informed consent and design for clinical trials targeting high-risk individuals.
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Al-Janabi, Omar M. "CEREBROVASCULAR RISK FACTORS, ARTERIOLAR SCLEROSIS, AND COGNITIVE DECLINE IN THE KENTUCKY APPALACHIAN “STROKE-BELT”." UKnowledge, 2016. http://uknowledge.uky.edu/medsci_etds/5.
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The relationship between cerebrovascular disease (CVD) risk factors and cognitive impairment or dementia has been widely studied with significant variability in findings between groups. We hypothesized that chronic small vessel injury in the form of arteriolar sclerosis, measured quantitatively using MRI to measure total white matter hyperintensity (WMH) volumes, would identify specific association of CVD risk factors and patterns of cognitive decline, associated with mild cognitive impairment of the cerebrovascular type, that represent the core features of vascular cognitive impairment in our cohort.
A Cross-sectional analysis of clinical and quantitative MRI data on 114 subjects with normal cognitive function (n=52) and mild cognitive impairment (MCI; n=62) was performed. Quantitative total WMH volumes were examined in relation to potentially causative CVD risk factors and resultant test scores across cognitive domains using linear regression models adjusted for age, gender, and education.
Among CVD risk factors analyzed, age (p< 0.001), education (p= 0.003), hypertension (p= 0.012), and hyperlipidemia (p= 0.008) demonstrated the strongest associations with WMH volumes. Conversely, diabetes, smoking, history of heart attacks, atrial fibrillation, and history of stroke that have shown associations with CVD pathology on imaging in other studies were not statistically associated with increased WMH in this cohort. WMH volumes were associated with decrease performance on the Trial Making Test type A & B and long delayed free recall on the California Verbal Learning Test.
Our findings suggest similarities and yet differences in comparison to other studies. Hypertension and hyperlipidemia appear to represent common shared risks across geographically disparate groups. Our findings, like others, suggest CVD pathology impact processing speed and executive function and provide further evidence for CVD effects on short-term memory in those at risk for cognitive decline and the future development of dementia in our cohort.
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Christensen, Janelle J. "Hurricane Preparedness of Community-Dwelling Dementia Caregivers in South Florida." Scholar Commons, 2012. http://scholarcommons.usf.edu/etd/4010.
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The aim of this dissertation is to explore how informal caregivers for people with dementia (PWD), who are community dwelling (i.e., not in nursing homes), prepare and plan for disasters. The research site is a particularly hurricane-prone region of Florida, second only to New Orleans in its vulnerability. An underlying assumption of this research is that caregivers for PWD have to plan and anticipate problems that are unique to their role. The rationale for the study described here is that disaster planning and mitigation save lives (Tengs et al. 1995), but there is little or no literature on disaster planning for the frail elderly and their caregivers.
Mixed methods design which includes: 1) participant observation; 2) staff interviews (n=8);3) preliminary caregiver interviews (n=5); 4) baseline chart/disaster plan review (n=290);5) intervention (presentation to staff and administration) and form revision; 6) follow-up chart/ disaster plan review (n=259); 7) caregiver survey(n=253);8) final caregiver interviews (N=15- total number of caregiver interviews 20); 9) disaster literacy testing (n=20); 10) final group interview with ACC administration.
This work documents the way that caregivers talk about disaster planning and say they will do if a hurricane strikes and reflects on their past hurricane experiences. Major findings include gaps in the county run Special Needs Shelter services available in Florida for people with dementia. The response and difficulty that caregivers might face can depend on the stage of the disease.
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Silva, Magnolia Moreira da. "Associação entre fatores de risco cardiovasculares e demência vascular definitiva." Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-05112018-151715/.
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Introdução: Estudos prévios analisaram a associação entre fatores de risco cardiovascular (FRCV) associados ao diagnóstico de demência vascular (DV) provável ou possível. No entanto, não foram encontrados estudos que analisassem a associação entre FRCV e a ocorrência de DV definitiva. Dessa maneira, ainda permanece obscura a associação entre os FRCV e a ocorrência de DV definitiva, ou seja, aquela diagnosticada por meio do exame neuropatológico, no qual se apresenta como padrão ouro. Objetivo: Avaliar a associação entre os FRCV e a ocorrência de DV definitiva, pura e mista. Método: Por meio de um estudo transversal foram analisados 707 casos pertencentes à casuística do Banco de Encéfalos Humanos do Grupo de Estudos em Envelhecimento (BEHGEEC) da FMUSP, que respeitaram os critérios de inclusão. A existência de fatores de risco cardiovascular em vida (Hipertensão Arterial, Diabetes Mellitus, Dislipidemia, Tabagismo, Etilismo, Obesidade e Sedentarismo), reportada por um informante com convivido minimamente semanal durante a autópsia, foi associada ao diagnóstico neuropatológico de demência vascular emitido por um neuropatologista. Modelos de regressão logística (sem e com ajuste para sexo, idade e raça) foram construídos para testar a associação entre os FRCV e o diagnóstico de DV, DV pura e DV mista. Foi testada a capacidade preditiva dos fatores que se mostraram preditores de DV por meio da Curva ROC. Resultados: O sedentarismo foi um preditor independente de DV (OR 1,943; IC95% 1,198 3,151; p= 0,007) e DV pura (OR 3,148; IC95% 1,428 6,941;p= 0,004). A HAS foi um preditor independente de DV mista (OR 2,240; IC95% 1,216 4,126; p= 0.01). O sedentarismo não apresentou boa capacidade preditiva para a DV e DV Pura (AUC = 0,380 e 0,337, respectivamente), assim como a HAS para a DV Mista (AUC = 0,459). Conclusões: Dentre os FRCV o sedentarismo e a HAS foram os que se associaram a um aumento no risco de DV.Introduction: Previous studies have analyzed the association between cardiovascular risk factors (CVRF) associated with the diagnosis (probable or possible) of vascular dementia (VaD). However, there are no studies that have analyzed the association between CVRF and the occurrence of definitive VaD. The association between CVRF and the occurrence of definite VaD, neuropathologically defined and considered as gold-standard, remains obscure. Objectives: To evaluate the association between CVRF and the occurrence of definitive VaD, pure and mixed. Methods: This is a cross-sectional study which evaluated 707 cases belonging to the Bain Bank of the Brazilian Aging Brain Study Group (BBBABSG) of FMUSP, respecting the inclusion criteria. The history of existence of cardiovascular risk factors in life (hypertension, diabetes mellitus, dyslipidemia, smoking, alcoholism, obesity, and sedentarism) reported by a knowledgeable next-of-kin, with at least weekly contact with the deceased, was associated with the neuropathological diagnosis of vascular dementia reported by a neuropathologist after the autopsy exam. Logistic regression models (with and without adjustment for sex, age and race) were tested to show the association between CVRF and the diagnosis of VaD, pure Vad and mixed VaD. It was also tested the predictive capacity of the factors that proved to be predictors of VaD through the ROC Curve. Results: Sedentary lifestyle was an independent predictor of VaD (OR 1,943, CI 95% 1,198 - 3,151, p = 0.007) and of Pure VaD (OR 3,148, 95% CI, 1.428 - 6.941, p = 0.004). Hypertension was an independent predictor of Mixed VaD (OR 2,240, 95% CI 1,216 - 4,126, p = 0.01). Sedentary lifestyle did not present good predictive capacity for VaD and Pure VaD (AUC = 0.380 and 0.337, respectively), as Hypertension for Mixed DV did not either (AUC = 0.459). Conclusions: Among the CVRF, sedentarism and hypertension were those associated with an increase VaD risk.
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Israelsson, Larsen Hanna. "Comorbidity and vascular risk factors associated with idiopathic normal pressure hydrocephalus : the INPH-CRasH Study." Doctoral thesis, Umeå universitet, Institutionen för farmakologi och klinisk neurovetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-120175.
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Idiopathic normal pressure hydrocephalus (INPH) is a dementia treatable by insertion of a cerebrospinal fluid shunt. It has been suggested that INPH has similar pathophysiological mechanisms as cerebrovascular disease, but the vascular risk factor (VRF) profile of INPH patients has not been assessed using a modern epidemiological approach. The cognitive symptoms of INPH resemble the symptoms of depression, but the prevalence of depression among INPH patients is unknown. In addition, few studies investigate the impact of shunting on the quality of life (QoL), and no study has investigated the impact of comorbidity on QoL in INPH patients. The objective of this dissertation was to present the VRF profile of INPH and to investigate the hypothesis that INPH may be a subgroup of vascular dementia. Additional objectives were to assess the prevalence of depression in INPH patients and to investigate the impact of shunting and comorbidities on QoL in INPH. In the first cohort, the prevalence of possible INPH was assessed through clinical and radiological examinations in patients with a transient ischemic attack (TIA), consecutively admitted to the same hospital during 2006-2008. In the second cohort, VRFs, vascular disease and QoL were analysed in INPH patients consecutively shunted 2008-2010 in five out of six neurosurgical centres in Sweden. Patients remaining after inclusion (n=176, within the age-span 60-85 years and not having dementia) were compared to population-based age- and gender-matched controls (n=368, same inclusion criteria as for the INPH patients). Assessed VRFs were: hypertension, diabetes, obesity, hyperlipidemia, psychosocial factors (stress and depression), smoking, alcohol intake, physical activity and, dietary pattern. Cardiovascular, cerebrovascular and peripheral vascular disease as well as QoL were also assessed. Parameters were assessed through questionnaires, clinical examinations, measurements, ECG and, blood samples. In the first cohort, 4% of the TIA patients had clinically and radiologically verified INPH. In the second cohort, VRFs were overrepresented among the INPH patients compared with the controls. The VRFs independently associated with INPH were: hyperlipidemia (Odds ratio (OR): 2.4, 95%CI: 1.4-4.0), diabetes (OR: 2.2, 95%CI: 1.2-3.9), obesity (OR: 5.4, 95%CI: 2.5-11.8) and, psychosocial factors (OR: 5.3, 95%CI: 3.2-8.9). When adding the VRFs that were overrepresented in INPH, although not independently (physical inactivity and hypertension), these six VRFs accounted for 24% of the INPH cases in the elderly population (population attributable risk %: 24). Depression was overrepresented in shunted INPH patients compared to the controls (46% vs. 13%, p<0.001) and the main predictor for low QoL was a coexisting depression (p<0.001). In conclusion, the results of the INPH-CRasH study are consistent with a vascular pathophysiological component of INPH and indicate that INPH may be subgroup of vascular dementia. In clinical care and research, a complete risk factor analysis as well as screening for depression and a measurement for quality of life should be included in the work-up of INPH patients. The effect of targeted interventions against modifiable VRFs and anti-depressant treatment in INPH patients should be evaluated.Idiopatisk normaltryckshydrocefalus (INPH, från engelskans ”idiopathic normal pressure hydrocephalus”) är en neurokirurgiskt behandlingsbar demens. Behandlingen är att operera in en shunt som dränerar cerebrospinalvätska från ventriklarna. Det har föreslagits att INPH skulle kunna orsakas av liknande patofysiologiska mekanismer som vid cerebrovaskulär sjukdom, men den vaskulära riskfaktorprofilen hos INPH-patienter har aldrig undersökts i en modern epidemiologisk studie. De kognitiva symtomen vid INPH påminner om symtomen vid depression, men prevalensen av depression hos INPH-patienter är okänd. Få studier undersöker hur shuntning påverkar livskvalitet och ingen studie har undersökt hur komorbiditet påverkar livskvaliteten vid INPH. Syftet med den här avhandlingen var att undersöka den vaskulära riskfaktorprofilen hos INPH-patienter samt att utforska hypotesen att INPH skulle kunna vara en undergrupp till vaskulär demens. Ytterligare ett syfte med avhandlingen var att undersöka hur många INPH-patienter som har depression samt undersöka hur shunting och komorbiditet påverkar livskvalitet vid INPH. I den första kohorten undersöktes kliniska och radiologiska fynd som tydde på INPH hos de patienter som blivit diagnostiserade med en TIA (från engelskans: transient ischemic attack) 2006-2008 på Norrlands Universitetssjukhus i Umeå. I den andra kohorten undersöktes konsekutivt shuntade INPH-patienter 2008-2010 från fem av sex neurokirurgiska kliniker i Sverige. De patienter som inkluderades i studien (n=176, ålder: 60-85 år, ej dementa) jämfördes med köns- och åldersmatchade kontroller från normalpopulationen (n=368, samma inklusionskriterier som för INPH-patienterna). De riskfaktorer som undersöktes var: hypertension, hyperlipidemi, diabetes, fetma, psykosociala faktorer (stress och depression), rökning, alkohol, fysisk aktivitet och diet. Även kardiovaskulära och cerebrovaskulära sjukdomar undersöktes, liksom perifer vaskulär sjukdom samt livskvalitet. Datainsamling skedde genom frågeformulär, kliniska undersökningar, mätningar, EKG och blodprov. I den första kohorten hade 4% av TIA-patienterna kliniskt och radiologiskt verifierad INPH. I den andra kohorten var vaskulära riskfaktorer överrepresenterade hos INPH-patienterna jämfört med iv normalpopulationen. Hyperlipidemi (OR: 2.4, 95%CI: 1.4-4.0), diabetes (OR: 2.2, 95%CI: 1.2-3.9), fetma (OR: 5.4, 95%CI: 2.5-11.8) och psykosociala faktorer (OR: 5.3, 95%CI: 3.2-8.9) var associerade med INPH oberoende av kön, ålder och de andra riskfaktorerna. Hypertension och fysisk inaktivitet var också associerade med INPH, dock inte oberoende av övriga riskfaktorer. Sammanlagd PAR% (från engelskans: population attributable risk %) för de här sex riskfaktorerna var 24%. INPH-patienterna hade depression i högre utsträckning än kontrollerna (46% vs. 13%, p<0.001), och depression var den viktigaste prediktorn för låg livskvalitet. Resultaten tyder på att vaskulär sjukdom och vaskulära riskfaktorer är involverade i den patofysiologiska mekanismen vid INPH. INPH kan vara en undergrupp till vaskulär demens. En fullständig riskfaktoranalys och screening för depression bör ingå i den preoperativa utvärderingen såväl som i forskning på INPH-patienter, och ett mått på livskvalitet bör införas. Effekten av riktade insatser mot såväl vaskulära riskfaktorer som depression vid INPH bör utvärderas.
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Gopu, Anusharani. "Using non-medical risk factors related to dementia and cognitive decline for developing an evidencebased e-health tool." Thesis, KTH, Skolan för informations- och kommunikationsteknik (ICT), 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-199191.
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The number of dementia cases is increasing worldwide. Most research and development in this area is related to the prevention of dementia, and to the development of various prediction tools for dementia. The tools made available take most of the medical data into account while calculating risk scores, with only a small amount of non-medical data. There is a lot of data related to medical and non-medical risk factors available from various sources which can be retrieved and analysed in real time, but this is today not used in any risk score tool for risk score calculation. As part of the project Multimodal strategies to promote a healthy brain in ageing: Innovative evidence-based tools (MULTI-MODE), a new risk score is being developed to be used in a new ICT-based tool for dementia prediction. Identification of non-medical data and a good model to fill the gap between data available at the server and using this data in risk score calculation may help in increasing the predictability of tools. In this thesis, some of the existing risk factors for the prediction of dementia are described, and the importance of non-medical factors in calculating risk scores is discussed. Additional non-medical factors are identified that could be included in future versions of the risk score. A database design for storing risk score information efficiently is presented, as is an app structure that can be used at the server side to validate the user input and to increase the effectiveness of a prediction tool.Antal demensfall ökar över hela världen. Forskning och utveckling inom detta område är relaterat till att förebygga demens och att utveckla olika prognosverktyg för demens. Flera tillgängliga verktyg tar hänsyn till medicinska data i beräkning av riskpoäng, med endast en liten mängd av icke-medicinska data. Det finns en hel del data om medicinska och icke-medicinska faktorer online, men de används idag inte för riskpoängberäkning. Som en del av projektet Multimodala strategier för att främja en frisk hjärna i åldrande: Innovativa evidensbaserade verktyg (MULTI-MODE), så har en ny metod utvecklats för att användas i ett nytt IT-baserat verktyg för demensförutsägelse. Identifiering av icke-medicinska data och en bra modell för att överbrygga gapet mellan tillgängliga data på servern och använda dessa data i riskberäkning kan bidra till att öka precisionen hos verktyg. I den här studien beskrivs en del befintliga riskfaktorer för förutsägelse av demens och vikten av icke-medicinska faktorer i beräkning av risk diskuteras. Ytterligare icke-medicinska faktorer identifieras som skulle kunna ingå i framtida versioner av riskverktyg (såsom appar). Vissa identifierade riskfaktorer har analyserats och visade att effekten av att införa icke-medicinska faktorer ökar precisionen i resultaten. En databasdesign för lagring av riskinformation på ett effektivt sätt presenteras, liksom en appstruktur som kan användas på serversidan för att validera några av de parametrar som kan öka effektiviteten av verktyget.
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Xu, Xin. "Physical, psychological, demographic and modifiable risk factors for age related cognitive impairment associated with possible dementia and frailty." Thesis, Loughborough University, 2014. https://dspace.lboro.ac.uk/2134/14542.
Full textAbstract:
The population of China is ageing. Accompanying this aging population, dementia and frailty have a growing importance. However there is little consensus on the association between dementia and frailty, in terms of how the criteria that are part of this two syndromes overlap, as both disorders are age-related and increase the risk for falls, further leading to loss of independence. To meet the above needs, the thesis describes research into different frailty diagnostic criteria, as well as its association with dementia symptoms. We examined cognitive measures that can be used for assessment of Mild Cognitive Impairment (MCI) and dementia screening (the Hopkins Verbal Learning Test, HVLT) and compared its discriminant ability with the commonly used cognitive screening tool, the Mini-Mental State Examination (MMSE) in distinguishing Cognitive Impairment (including MCI and dementia) from No Cognitive Impairment (NCI, normal controls) in two community-dwelling elderly Chinese populations and in one institutionalised elderly population in Shanghai, China. Subsequently we investigated whether physical and cognitive symptoms clustered together to form frailty phenotypes. We employed indicators that have been widely used to diagnose frailty, including physical measures (grip strength, Time-Up and Go test, 15 feet gait speed test and Berg balance test), and psychological measures (the HVLT and the MMSE) to predict cognitive impairment (CI) and frailty. Additionally, we described demographics (age, gender, education) and other potential modifiers when detecting cognitive impairment and functional disability. We then built up a model for possible frailty phenotype using various indicators. Lastly, we examined whether demographic (age, gender, education and profession), and lifestyle (smoking/alcohol history, exercise frequency, and dietary habit) could be used to predict future cognitive impairment. It was found that advanced age, lower education (no or primary level), and being vegetarian were significant risk factors for cognitive impairment. Furthermore, whereas high consumption of green vegetables is a protector against cognitive impairment, high intake of tofu was negatively related to cognitive performance among community-dwelling elderly in China. To meet the above needs, the thesis describes research into different frailty diagnostic criteria, as well as its association with dementia symptoms. We examined cognitive measures that can be used for assessment of Mild Cognitive Impairment (MCI) and dementia screening (the Hopkins Verbal Learning Test, HVLT) and compared its discriminant ability with the commonly used cognitive screening tool, the Mini-Mental State Examination (MMSE) in distinguishing Cognitive Impairment (including MCI and dementia) from No Cognitive Impairment (NCI, normal controls) in two community-dwelling elderly Chinese populations and in one institutionalised elderly population in Shanghai, China. Subsequently we employed these two cognitive measures to investigate whether they were part of the frailty syndrome among elderly from the community-based studies. We investigated whether physical and cognitive symptoms clustered together to form frailty phenotypes. We employed indicators that have been widely used to diagnose frailty, including physical measures (grip strength, Time-Up and Go test, 15 feet gait speed test and Berg balance test), and psychological measures (the HVLT and the MMSE) to predict cognitive impairment (CI). We found four distinct subtypes of elderly characterised by increasing care needs: 1. Persona elderly as defined by age >78, year of education<6 years, grip strength <11.8 KG, and a MMSE total score <25; 2. Persona Physical frailty (fitness), defined by a total score on the Timed-Up and Go (TUG) test >12.7 seconds and 15 feet gait speed >4.4 seconds; 3. Persona Cognitive impairment, defined by a MMSE total score <25, a HVLT Immediate Recall (IR) score <15, and a HVLT Delayed Recall (DR) <5; 4. Persona Physical frailty (balance,) defined by a Berg Balance test score of <53. Additionally, we described demographics (age, gender, education) and other potential modifiers when detecting cognitive impairment and functional disability. We then built up a model for possible frailty phenotype using various indicators, Frailty here was defined as: 1. Low BMI as measured by this algorithm: BMI= Weight (kg)/Height (m)2 2. Weakness (upper and lower body): grip strength in the lowest quintile, adjusted for gender; and TUG get up with assistance or unable to get up 3. Slowness (lower body): TUG score in the lowest quintile, adjusted for gender; and 15 feet gait speed in the lowest quintile, adjusted for gender; 4. Poor balance: Berg Balance test score in the lowest quintile, adjusted for gender; 5. Low physical activity: engaging in exercise less than once per week. An individual with 4 or more present frailty components out of a total of 7 was considered to be frail , whereas equal or less than 3 characteristics were hypothesized to be pre-frail . Those with no present frailty components were considered as robust. Lastly, we examined whether demographic (age, gender, education and profession), and lifestyle (smoking/alcohol history, exercise frequency, and dietary habit) could be used to predict future cognitive impairment (as defined by a HVLT IR score of ≤19). The results of our studies show that compared to the MMSE, the HVLT is superior in differentiating MCI and dementia from NCI, and is also less affected by demographic factors in detecting frailty. Furthermore, in the current study, physical, psychological, demographic and other modifiable risk factors cluster together into different phenotypes of cognitive impairment and functional disability in these cohorts. A phenotype of frailty is built up using BMI, grip strength, TUG, 15 feet gait speed, balance and exercise frequency as indicators. The most common was the elderly phenotype followed by the cognitively impaired. A novel finding of the current study is that only 4.8% (8 out 168) of the whole sample fulfilled all three categories in the current study (cognitive impairment, functional disability and frailty). Finally, advanced age, lower education (no or primary level), and being vegetarian were significant risk factors for cognitive impairment. Furthermore, whereas high consumption of green vegetables is a protector against cognitive impairment, high intake of tofu was negatively related to cognitive performance among community-dwelling elderly in China.
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Mathillas, Johan. "Dementia, depression and delirium in the very old : prevalences and associated factors." Doctoral thesis, Umeå universitet, Geriatrik, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-79984.
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Emotional suffering in old age is largely caused by a variety of psychiatric disorders which are often, however, undertreated and underrecognized. This leads to reduced quality of life and functional status and increased morbidity and mortality. Dementia, delirium and depression are common disorders in the very old, and are similar in several ways. All have multiple causes and are diagnosed by means of symptomatic criteria, are challenging to diagnose and difficult to differentiate from each other in the very old. They often coexist in the same individual, and may have common risk factors. The overall aim of this thesis was to add to our knowledge about threats to successful aging, by investigating the prevalences of dementia, depression and delirium, and factors associated with these three disorders. Further aims were to measure change over time in the prevalence of dementia and depression, respectively, and to investigate the risk factors for incident depression. This thesis uses the population-based Umeå85+/GErontological Regional DAtabase (GERDA) material. In 2000-2002, every other 85-year-old, all 90-year-olds and all people ≥95 years living in six municipalities in Västerbotten, Sweden were invited to participate, and in 2005-2007 the process was repeated, with the additional inclusion of the corresponding populations of two municipalities in Österbotten, Finland. A third data collection was carried out in 2010-2012. Trained assessors carried out assessments in the form of structured interviews during one or more home visits, recorded current medication and reviewed medical records obtained from general practitioners and hospitals. In 2000-2002 the prevalence of dementia was 17% among 85-year-olds, 24% among 90-year-olds and 46% among those aged ≥95 years. In 2005-2007 dementia prevalence reached 28% among 85-year-olds, 40% among 90-yearolds and 45% among those aged ≥95 years. The prevalence of dementia in the total sample was 27% in 2000-2002 and 37% in 2005-2007 (p=0.001). In 2000-2002 the prevalence of depressive disorders was 24% among 85-yearolds, 34% among 90-year-olds and 31% among those aged ≥95 years. In 2005-2007 the prevalence of depressive disorders was 33% among 85-year-olds, 39% among 90-year-olds and 38% among those aged ≥95 years. The prevalence of depressive disorders in the total sample was 29% in 2000-2002 and 37% in 2005-2007 (p=0.025). Among participants not depressed at baseline, 26% had developed depression after five years. Factors independently associated with new cases of depression at follow-up were hypertension, a history of stroke and a higher score on the 15-item Geriatric Depression Scale at baseline. The thirtyday prevalence of delirium in 2005-2007 was 17% among 85-year-olds, 21% among 90-year-olds and 39% among participants aged ≥95 years. Delirium prevalence among individuals with dementia was higher than among those without dementia (52% vs. 5%, p<.001). Factors independently associated with delirium superimposed on dementia in a multivariate logistic regression model were depression, heart failure, living in an institution and prescribed antipsychotics. There was a high prevalence of dementia, depression and delirium in the papers comprising this thesis, and 55% had at least one of the three disorders. The prevalence of dementia and depression also increased between 2000-2002 and 2005-2007, after controlling for age and sex. Dementia and depression were important associated factors for delirium and half of those with dementia were depressed. The increasing age-specific prevalence of depression seems to be associated with the increasing age-specific prevalence of dementia. The papers presented are among the first to report a significantly increasing age-specific prevalence of dementia and depression among very old people. More knowledge about associated factors and risk factors concerning these disorders may be helpful for carers and decision-makers, as well as providing reference values for studies in other regions. Further efforts are needed in both care and research to better prevent, screen for, diagnose and treat dementia, depression and delirium, especially considering the growing number of very old people.Umeå85+/GERDA
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Lundström, Maria. "Delirium in old patients with femoral neck fracture : risk factors, outcome, prevention and treatment /." Umeå : Univ, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-379.
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Lundström, Maria. "Delirium in old patients with femoral neck fracture : risk factors, outcome, prevention and treatment." Doctoral thesis, Umeå universitet, Geriatrik, 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-379.
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Delirium is probably the most common presenting symptom of disease in old age. Delirium, as defined in DSM-IV, is a neuropsychiatric syndrome characterized by disturbance in attention and consciousness, which develops over a short period of time and where the symptoms tend to fluctuate during the course of the day. The overall aim was to increase knowledge about the risk factors and outcome of delirium in old patients with femoral neck fracture and to develop and evaluate a multi-factorial intervention program for prevention and treatment of delirium in these patients. In a prospective study of 101 consecutive patients with a femoral neck fracture, 29.7% were delirious before surgery and another 18.8% developed delirium postoperatively. Of those who were delirious preoperatively all but one remained delirious postoperatively. The majority of those delirious before surgery were demented, treated with drugs with anticholinergic properties (mainly neuroleptics), had had previous episodes of delirium and had fallen indoors. Patients who developed postoperative delirium had perioperative falls in blood pressure and seemed to have more postoperative complications, such as infections. Patients with preoperative delirium had a poorer walking ability on discharge compared to patients with postoperative delirium only. In a five-year prospective follow up study 30 out of 78 (38.5%) non-demented patients with a femoral neck fracture developed dementia. Twenty out of 29 (69%) who were delirious postoperatively developed dementia compared to 10 out of 49 (20%) who were not delirious during hospitalization (p<0.001). Twenty-one (72.4%) of those with postoperative delirium died within 5 years compared to 17/49 (34.7%) of those who remained lucid postoperatively (p=0.001). A non-randomized multi-factorial intervention study with the aim of preventing and treating delirium among patients with femoral neck fracture (n=49) showed that the incidence of delirium was significantly lower than reported in previously published studies. The incidence of other postoperative complications was also lower and a larger proportion of the patients regained independent walking ability and could return to their previous living conditions on discharge. A similar multi-factorial intervention program evaluated as a randomized controlled trial including 199 femoral neck fracture patients showed that fewer intervention patients than controls suffered postoperative delirium (56/102, 55% vs. 73/97, 75%, p=0.003). For intervention patients the postoperative delirium was also of shorter duration (5.0±7.1 days vs. 10.2±13.3 days, p=0.009). Eighteen percent in the intervention ward and 52% of controls were delirious after the seventh postoperative day (p<0.001). Intervention patients suffered from significantly fewer in-hospital complications, such as decubital ulcers, urinary tract infections, nutritional complications, sleeping problems and falls, than controls. Total postoperative hospitalization was shorter in the intervention ward (28.0±17.9 days vs. 38.0±40.6 days, p=0.028). In conclusion, pre- and postoperative delirium is common and seems to be associated with various risk factors, which require different strategies for prevention and treatment. Delirium is also associated with the development of dementia and a higher mortality rate. Multifactorial intervention programs can successfully be implemented and result in the reduction of delirium, fewer complications and shorter hospitalization.
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Mohammad, Hameed. "Mid-to-late life overweight and obesity and the risk development of dementia: A systematic review of the literature." Thesis, Mohammad, Hameed (2020) Mid-to-late life overweight and obesity and the risk development of dementia: A systematic review of the literature. Masters by Coursework thesis, Murdoch University, 2020. https://researchrepository.murdoch.edu.au/id/eprint/59020/.
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Scope: Mid-life overweight and obesity are the potentially leading causes of late-life dementia and its subtypes. This systematic literature review assessed the epidemiological evidence of the association between mid-to-late life overweight/obesity and the future risk development of dementia.
Methods: A systematic literature search in published peer-reviewed journals between 2003 and 2019 was conducted to identify prospective and retrospective cohort and case-control studies reporting mid-to-late life overweight and obesity by dementia risk. Of the 610 abstracts identified and reviewed from the main scientific databases, 17 high-quality original research studies were included for the final analysis, which has entirely met the study inclusion criteria. The studies were limited to humans and English language publications. Study methods were summarised and tabulated according to the study characteristics, design, reported exposures to overweight and obesity, dose-response relationship, and type of dementia outcome. The strength of association between mid-to-late life overweight and obesity with dementia risk contributed by each study was assessed consistently, and the main limitations of the included studies were discussed.
Results: The study results were based on 2,048,255 participants with a follow-up period ranging between 3 to 36 years. Seventeen full-text articles were examined. Of these, 13 studies assessed mid-life overweight/obesity and the risk of late-life dementia, and four studies evaluated late-life overweight/obesity and the risk of dementia. The association between overweight and obesity with dementia risk is varied from mid-life to late-life. Most of the mid-life reviewed studies reported that being overweight and obese at mid-life had a positive association with an increased risk of dementia in late-life, although the results were inconsistent across some studies. A negative association between late-life overweight and obesity with the risk of dementia was reported in late-life studies. The dose-response relationship between mid-to-late life elevated BMI and dementia risk reported a positive association across eight out of 17 studies.
Conclusions: The current epidemiological evidence from this systematic review suggests that mid-life overweight and obesity could increase the risk development of late-life dementia. However, there is a lower or reduced risk development of dementia was observed related to being overweight and obese in late-life. This study has significant implications for future public health policymaking and disease-modifying interventions at the population level.
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Peters, Ruth. "Risk factors for incident cognitive decline and dementia in a very elderly hypertensive population : a two year prospective cohort study." Thesis, Imperial College London, 2008. http://hdl.handle.net/10044/1/11863.
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Eriksson, Sörman Daniel. "The influence of social relationships and leisure activity on adult cognitive functioning and risk of dementia : Longitudinal population-based studies." Doctoral thesis, Umeå universitet, Institutionen för psykologi, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-101840.
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Today, as we live longer, dementia diseases are becoming more prevalent around the world. Thus, further knowledge of how to maintain levels of cognitive functioning in old age and how to identify factors that postpone the onset of dementia are of acute interest. Lifestyle patterns and social life are important aspects to consider in this regard. This thesis includes three studies. Study I investigated the association between participation in various leisure activities in old age (≥65 years) and risk of incident all-cause dementia. Analyses of the total follow-up time period (15 years) showed that higher levels of “Social” and “Total” leisure activity were associated with decreased risk of dementia. In Study II, the aim was to investigate the association between various aspects of social relationships in old age (≥65 years) and risk of incidents of all-cause dementia and Alzheimer's disease. Results showed that over the total follow-up period (16 years) higher values on the relationship index were associated with reduced risk of both dementia and Alzheimer's disease. Visiting/visits of friends and acquaintances more than once a week was related to decreased risk for all-cause dementia, but not for Alzheimer's disease. However, in neither Study I nor II did any of these factors alter the risk of all-cause dementia or Alzheimer's disease when near-onset dementias were removed from the analyses (Study I, up to five years; Study II, up to three years). In Study III the aim was to investigate the association between social network size and cognitive ability in a middle-aged (40–60 years) sample. The idea was that if social network size can moderate negative age-related influence on memory functions, it might also put an individual on a cognitive trajectory that is beneficial in old age. Results from longitudinal analyses showed that baseline network size was positively related to five-year changes in semantic memory and with changes in both semantic and episodic memory at the ten-year follow-up. Social network size was unrelated to changes in visuospatial performance. Taken together, enrichment factors measured in old age (≥ 65 years) did not alter the risk of all-cause dementia or Alzheimer's disease when near-onset dementias were removed from the analyses. These results might reflect protective short-term effects or reverse causality, meaning that in the prodromal phase of dementia individuals tend to withdraw from activity. Social network size in middle age (40-60 years), however, appears to have beneficial long-term effects on cognitive functioning. The results highlight the importance of long follow-up periods and the need to adjust for the influences of reverse causality when investigating the impact of a socially and mentally active life on cognitive functioning.
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Huang, Lan-Ya, and 黃蘭雅. "Risk factors for Dementia in Down syndrome." Thesis, 2016. http://ndltd.ncl.edu.tw/handle/54225985401574473028.
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碩士國立臺灣大學
分子醫學研究所
104
Background Down syndrome (DS) is one of the most common mental retardation chromosomal disorder in Taiwan. Even though our healthcare system encourages Down syndrome screen，there is still a number of babies with DS delivered. DS babies will have be problems congenital anomalies and need to be paid more attention in education. When turning into adulthoods, early degeneration is a major concern, such as dementia. The cause of dementia in DS is not well delineated. In this study, we would like to evaluate the role of single nucleotide polymorphism (SNPs) in DS with dementia. Method We compared the percentage of several SNPs in DS with and without dementia, including 12 SNPs in APOE、ESR2、CYP17 and CYP19 genes (rs405509, rs429358, rs7412, rs17766755,rs4365213, rs12435857, rs4986938, rs6163,rs3740397,rs10786712,rs743572, and rs1870049). ABDQ (Adaptive Behaviour Dementia Questionnaire) scores, age, sex, IQ, and behavior problems were also analyzed. Result Total 23 DS subjects and 49 healthy subjects were analyzed. The dementia in DS is positively correlated with behavioral problems, IQ, ABDQ scores (p<0.001). In addition, APOE
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Lu, Yun-Ru, and 盧韻如. "Risk factors in survival of vascular dementia." Thesis, 2010. http://ndltd.ncl.edu.tw/handle/47901275615867116631.
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碩士臺灣大學
流行病學研究所
98
Background There were many survival suturies of Alzheimer''s Disease or oveall dementia. But,the study about survival of vascular dementia was few.It is fact that the etiologies of dementia are variable.The effect of vascular risk factors on dementia mortality were underestimated due to the error anaylsis of oveall dementia patients rather than vascular dementia patients.Our study was a longitudinal study of patients of vascular dementia.We recorded the whole history from stroke to vascular dementia and final mortality course in hospital.Based on the records , we want to know what risks factors were related to mortality of vascular dementia. Objective To investigate what risks factors were contributioned to mortality of vascular dementia.The risk factors include as follows: age、gender、diabetes mellitus、hypertension、angima、atrial fibrillation、poststrpke bed-ridden state、poststroke epilepsy、congestive heart failure、sepsis、the time between stroke and dementia、poststroke brain image findings.According to the survival study of vascular dementia, we could know what risk factors were highly related to mortality and we can early prevent it with drugs or health education. Method We used medical record review system to identify cases of vascular dementia from January 1, 2004 to December 31, 2009. 54 patients were identified by the criteria of National Institute of Neurological Disorders and Stroke -Association International pour la Recherché et l''Enseignement en Neurosciences (NINDS –AIREN criteria) Patients with VaD were followed from the day of VaD diagnosis to death, or the end of study. All the patients were arranged a series of tests as follows, neurological examination revealed focal neurological symptoms and signs, and serological test for dementia survey, such as T4, TSH, and VDRL. Besides, Brain CT or MRI was done to check the poststroke states and brain atrophy. Cox proportional hazards models were used to evaluate the effects of risk factors on VaD. In addition, the estimated median survival time and five-year survival rate were obtained from the Kaplan-Meier method. Result The mean age of VaD was 81.53±7.36 years.Five year survival rate was 34%. At the ending of study, there were 12 deaths among patients. There were 8 patients died from aspiration pneumonia, 1 patients died from recurrent stroke, and 1 patient died from lung cancer,1 patient died from traumatic SAH due to fall down. The RR of death was 32.27(95%CI, 6.04-172.4) in VaD patients with congestive heart failure. The RR of death was 44.79(95%CI,12.10-165.8) in VaD patients with septic shock.The Kaplan-Meier survival curves showed the trend in poor survival amongVaD patients with multiple vascular factors.Besides,VaD patients with brain image showed periventricular white matter change has better survival tham patients with brin image showed a single strategically infarct. Conclusion Five-year survival rate was 34%. Aspiration Pneumonia was the major mortality cause in our patients. Septic shock and CHF were time-dependent variables in survival of VaD. The major cause of Sepsis was aspiration pneumonia.The RR of death was 33.20 in VaD patients with septic shock adjusted by CHF.There was trend with lower survival rate among VaD patients of multiple vascular risk factors.
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Lee, Jiann-Der, and 李建德. "The Risk Factors of Dementia in Hemodialysis Patients." Thesis, 2005. http://ndltd.ncl.edu.tw/handle/44246199248014419546.
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碩士國立中興大學
生命科學院碩士在職專班
93
Dementia is one of the major causes of disability in hemodialysis patients. The purpose of this study was to evaluate the prevalence and type of dementia in hemodialysis patients, and to correlate factors which might contribute to dementia in these patients. The dementia-associated factors including age, literacy, cholesterol, triglycerides, albumin, homocysteine, diabetes mellitus, hypertension, and stroke, ischemic heart disease, and smoking were also to be determined. The predictive factor(s) for the serum concentration of homocysteine was also determined. In general, 147 hemodialysis patients from Kuang-Tien General Hospital were targeted to be analyzed. Cognitive function was evaluated by mini-mental status examination (MMSE), and dementia was further diagnosed based on the criteria of Diagnostic and Statistical Manual for Mental Disorders (DSM-IV). Hachinski ischemic scale was used to distinguish the types of dementia. Fluorescent polarizing immunoassay, chemiluminescence immunoassay, and latex agglutination test were used to determine the blood levels of homocysteine, folate & vitamin B12, and C-reactive protein, respectively. Results showed that among the 147 patients, 26 patients were diagnosed with dementia. The degenerative type dementia was more prevalent in these patients. Hemodialysis patients with hypoalbuminemia, old age, and illiteracy were prone to dementia. Although homocysteine was not statistically correlated with dementia of hemodialysis patients, we can not preclude the possibility yet because the levels of homocysteine in most of the hemodialysis patients remained above average. Multiple linear regression analysis indicates vitamin B12, creatinine, and C-reactive protein are the reliable predictors for homocysteine. Similar analyse further indicates age and triglycerides are the two reliable predictors for the change of plasma albumin.
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Chen, Chia-Wen, and 陳嘉雯. "Exposure of General Anesthesia on Risk of Dementia." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/06884107259767732084.
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Sequeira, Rodrigo Rodrigues Lucas Rei. "Dementia: risk factors for disease progression and mortality." Master's thesis, 2021. https://hdl.handle.net/10216/134579.
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Sequeira, Rodrigo Rodrigues Lucas Rei. "Dementia: risk factors for disease progression and mortality." Dissertação, 2021. https://hdl.handle.net/10216/134579.
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Hack, Erica. "Multilingualism and the risk of Alzheimer disease and dementia." Thesis, 2011. http://hdl.handle.net/10012/5999.
Full textAbstract:
Background: Alzheimer disease (AD) is a progressive, late-life neurodegenerative disorder. Given the aging population, AD is a significant health concern. According to the Alzheimer Society of Canada (Smetanin et al., 2009), in 25 years 2.8% of the Canadian population will have AD or a related dementia. Presently, there is no cure for AD; therefore, efforts to either delay AD onset or prevent AD altogether are a primary focus.
The ability to proficiently speak many languages has been associated with certain cognitive advantages. Based on these findings, multilinguals are hypothesized to be more resistant to cognitive decline than monolinguals. More research is warranted in order to further this theory and to contribute to strategies to prevent or delay AD.
Objectives: The first study objective was to evaluate whether multilingualism was associated with the development of AD. The second study objective was to assess whether multilingualism was associated with later dementia onset.
Methods: Analyses were based on data from the Nun Study, a longitudinal study of aging in 678 participants 75+ years living in the United States. In order to address the first study objective, the association between multilingualism and AD was assessed in 157 participants using logistic regression models adjusted for age, education, apolipoprotein E-E4 (ApoE-E4) status, immigrant status, and occupation. Additional subgroup analyses also included covariates associated with career length and linguistic ability (grammatical complexity and idea density). AD was diagnosed based on criteria for both clinical dementia and AD neuropathology. Dementia was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition criterion (American Psychiatric Association, 1994) (based on the Consortium to Establish a Registry for Alzheimer’s Disease battery of tests (Morris, Heyman, Mohs, & Hughes, 1989) and performance on activities of daily living), while AD neuropathology was based on the National Institute on Aging and Reagan Institute criterion (The National Institute on Aging - Reagan Institute (NIA-RI) Working Group on Diagnostic Criteria for the Neuropathological Assessment of Alzheimer's Disease, 1997). In order to address the second study objective, dementia likelihood was assessed in 325 participants using discrete-time survival analyses adjusted for age, ApoE-E4 status, education, and linguistic ability.
Results: When adjusted for age, education, ApoE-E4 status, occupation, and immigrant status, participants speaking two or more languages had similar AD risks compared to monolinguals (OR = 1.05; 95% CI = 0.45-2.50). However, when grammatical complexity was held constant across participants, speaking two or more languages was associated with a four-fold decrease in AD risk compared to speaking one language (OR = 0.25; 95% CI = 0.04-1.23), although this did not reach statistical significance.
When the association between multilingualism and time of dementia onset was assessed, the dementia hazard function estimates for all participants were constant and persisted throughout the follow-up period of the study. When ApoE-E4 status and baseline age were held constant, participants speaking four or more languages were significantly less likely to develop dementia than monolingual participants (OR = 0.14; 95% CI = 0.01-0.66). An interaction between multilingualism and the other two covariates (ApoE-E4 status and baseline age) was observed: the oldest participants with an ApoE-E4 allele who spoke four or more languages had smaller dementia risks than younger participants without an ApoE-E4 allele who spoke one, two, or three languages. Participants speaking two or three languages were no less likely than monolinguals to develop dementia across the study duration. When idea density was held constant across participants, multilingualism was associated with a nonsignificant decreased risk of dementia for individuals speaking three (OR = 0.62; 95% CI = 0.16-2.41) or four or more languages (OR = 0.53; 95% CI = 0.06-4.91) while participants speaking two languages were no more at risk for dementia than monolinguals (OR = 1.08; 95% CI = 0.43-2.69).
Discussion: Initially, multilingualism did not appear to confer protection against AD. After holding grammatical complexity constant across all participants, however, multilingualism was found to be associated with AD risk. Therefore, linguistic ability confounded the initial relationship measured by this study. When the association between multilingualism and time of dementia onset was evaluated, participants were no more likely to develop dementia in one time period than another, and monolingual participants were no more likely to develop dementia in earlier time periods than multilinguals. While a trend of decreasing dementia risk with ascending number of languages spoken was not observed, speaking four or more languages was consistently associated with decreased dementia risk compared to speaking one language. The presence of an ApoE-E4 allele and low linguistic ability had a strong and consistent significant association with increased AD and dementia risk. Therefore, the influence of these variables on the association of multilingualism with AD and dementia is worthy of further exploration.
Overall, this study provided some support for a protective effect of multilingualism on AD and dementia. Some of the present investigation’s results differ, however, from those of previous studies. This is not surprising, considering the present study utilized different methodologies than other studies in this research area. For instance, our study employed a definition of multilingualism based on self-report data – participants were classified as multilingual based on the number of languages they reported proficiency with. Therefore, our definition of multilingualism was less strict than definitions used in previous studies. However, our study employed much stricter outcome criteria than those used in previous studies, as our study is the first in this area to confirm AD cases with AD neuropathology evaluations. Our study is also the first io utilize prospective data and to include participants who remained dementia-free in addition to participants developing AD and dementia. In addition, this is the only study in this research area to evaluate the relationship of multilingualism with AD and dementia in the context of important covariates such as ApoE-E4 status and linguistic ability. Therefore, while some of our results contrast with other findings in this area, this is understandable given our novel methodologies. A broad range of study methods must be used in the future if we are to generate the depth of evidence needed for a full understanding of the relationship of multilingualism with AD and dementia. A better understanding of this relationship may also provide insight into both cognitive and brain reserve mechanisms, which could help more individuals maintain cognitive function into late life.
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Kuang-MingLiao and 廖光明. "Chronic Obstructive Pulmonary Disease Increased the Risk of Dementia." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/8gde89.
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Yang, Shen-Yin, and 楊聖盈. "The association between Leisure Activities and the Risk of Dementia." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/13154618398174045384.
Full textAbstract:
碩士國立臺灣大學
公共衛生碩士學位學程
99
Background: Previous studies found that leisure activities may decrease the risk of dementia, but results were inconsistent. Therefore, this study explored the association between different leisure activities and the risk of dementia. Methods: This is a case-control study. A total of 470 dementia patients [310 Alzheimer''s disease (AD) and 160 vascular dementia (VaD)] aged 50 or order was recruited from three teaching hospitals in northern Taiwan between 2007 and 2010. Health controls (n=499) were recruited from health checkup and volunteers of one hospital during the same time. Results: High frequency of physical activity was associated with a reduced risk of AD [odds ratio (OR) = 0.46, 95% confidence interval (CI) = 0.32-0.70)], results remained significant after stratified by gender (men: OR= 0.37; women: OR= 0.57). Similar finding was observed for high frequency of recreational, cognitive, productive activity (OR= 0.37, 95% CI= 0.18-0.77), and result remained significant among women (OR= 0.22), but not among men. Same for high social engagement activity (OR= 0.55, 95% CI= 0.38-0.79), but result remained significant only among men (OR= 0.48). For VaD, high frequency of physical activity and recreational, cognitive, productive activities were associated with a reduced risk of VaD (OR= 0.31, 95% CI = 0.18-0.54; OR= 0.24, 95% CI = 0.10-0.60, respectively). Physical activity was associated with a reduced risk of VaD after stratified by gender (men: OR= 0.25; women: OR= 0.41). Recreational, cognitive, productive activity was associated with a lower VaD risk in men (OR= 0.26, 95% CI= 0.08-0.85). Conclusion: High frequency of physical activity; recreational, cognitive, productive activity; and social engagement activity played a protective role on the risk of AD. Only the former two activities were associated with VaD. In addition, the associations were varied by gender. No interactions were observed for any two types of activities on the risk of AD and VaD.
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Lin, Chie-Yu, and 林婕妤. "Risk factors of survival rate on patients with organic dementia." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/66354360785457801985.
Full textAbstract:
碩士東吳大學
財務工程與精算數學系
99
In this research, data from “Psychiatric Inpatient Medical Claim Dataset” is used to study four risk factors of survival rate, including gender, onset age of organic dementia, history of diabetes and history of hypertension, on patients with organic dementia. Organic dementia patients are identified by using ICD-9-CM for the “290 senile and presenile organic psychotic conditions” or “294 other organic psychotic conditions (chronic).” A sample of 43,101 patients with organic dementia are observed from 1998-2009. For patients with organic dementia, the survival rate and hazard rate function are estimated by using Kaplan-Meier Product-Limit and Cox Proportional Hazard Model. The 43,101 patients with organic dementia are divided into 3 categories by their onset age, namely onset age “between 0-49 years,” “between 50-64 years” and “over age of 65.” Patients with different onset age category apply different hazard model. For patients with onset age between 0-49 years, "gender" and "history of hypertension" are major risk factors affecting survival rate; for those without history of diabetes, the "onset age of organic dementia" is also a risk factor for survival rate. For patients with onset age between 50-65 years, “gender,” “onset age of organic dementia” and “history of diabetes” are risk factors in survival rate. For patients with onset age over age 65, “onset age of organic dementia” and “history of diabetes” are risk factors affecting the survival rate of women; but of men, "history of hypertension" is also a risk factor. The estimation of patients’ survival rate after onset of dementia is lower than that besed on “2002 TSO Experience Mortality Table” and “Annuity Table in 1997”. That is, 2002 TSO Experience Mortality Table and Annuity Table in 1997 may not suit for estimating patients’ survival. In conclusion, when underwriting long-term care insurance, “history of diabetes” and “history of hypertension” of the insured had better be declared. For the in-force business, the hazard model could be a good reference for insurer to access future risk.