Publications by authors named "Efstathios Papachristou"

35 Publications

Comorbid chronic tic disorder and tourette syndrome in children requiring inpatient mental health treatment.

Clin Child Psychol Psychiatry 2021 Jul 16;26(3):894-905. Epub 2021 Apr 16.

National and Specialist Acorn Lodge Inpatient Children's Unit, Child and Adolescent Mental Health Services, South London and the Maudsley NHS Foundation Trust, London, UK.

Objective: Children needing admission to an inpatient mental health unit often present with severe neuropsychiatric disorders characterised by complex psychopathology. We aimed to examine all admitted children with comorbid chronic tic disorder (CTD) and Tourette syndrome (TS) over a 10-year period and determine the clinical significance of these diagnoses.

Method: A retrospective, naturalistic study was conducted, comparing children with and without CTD/TS in terms of co-morbid diagnoses, medication use, access to education, aggression contributing to the admission, duration of admission, functional outcomes and satisfaction with treatment. Data were analysed using Chi-square/Fisher's exact test and -test for categorical and continuous variables, respectively, and subsequently with unadjusted and adjusted linear and logistic regression analyses.

Results: A relatively high proportion of children had co-morbid CTD/TS (19.7%). There was a significant association with co-morbid obsessive-compulsive disorder, intellectual disability and autism spectrum disorder but not attention deficit hyperactivity disorder. CTD/TS were associated with longer admissions even after adjustments for confounding but did not seem to be independently associated with other examined clinical characteristics.

Conclusions: The prevalence of CTD/TS in children needing inpatient treatment is significant. In our sample, comorbid CTD/TS seem to represent a marker of overall symptom severity as evidenced by longer admissions.
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http://dx.doi.org/10.1177/13591045211007918DOI Listing
July 2021

Cortical thickness across the lifespan: Data from 17,075 healthy individuals aged 3-90 years.

Hum Brain Mapp 2021 Feb 17. Epub 2021 Feb 17.

Laboratory of Psychiatric Neuroimaging, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.

Delineating the association of age and cortical thickness in healthy individuals is critical given the association of cortical thickness with cognition and behavior. Previous research has shown that robust estimates of the association between age and brain morphometry require large-scale studies. In response, we used cross-sectional data from 17,075 individuals aged 3-90 years from the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) Consortium to infer age-related changes in cortical thickness. We used fractional polynomial (FP) regression to quantify the association between age and cortical thickness, and we computed normalized growth centiles using the parametric Lambda, Mu, and Sigma method. Interindividual variability was estimated using meta-analysis and one-way analysis of variance. For most regions, their highest cortical thickness value was observed in childhood. Age and cortical thickness showed a negative association; the slope was steeper up to the third decade of life and more gradual thereafter; notable exceptions to this general pattern were entorhinal, temporopolar, and anterior cingulate cortices. Interindividual variability was largest in temporal and frontal regions across the lifespan. Age and its FP combinations explained up to 59% variance in cortical thickness. These results may form the basis of further investigation on normative deviation in cortical thickness and its significance for behavioral and cognitive outcomes.
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http://dx.doi.org/10.1002/hbm.25364DOI Listing
February 2021

Subcortical volumes across the lifespan: Data from 18,605 healthy individuals aged 3-90 years.

Hum Brain Mapp 2021 Feb 11. Epub 2021 Feb 11.

Department of Psychology, Center for Brain Science, Harvard University, Cambridge, Massachusetts, USA.

Age has a major effect on brain volume. However, the normative studies available are constrained by small sample sizes, restricted age coverage and significant methodological variability. These limitations introduce inconsistencies and may obscure or distort the lifespan trajectories of brain morphometry. In response, we capitalized on the resources of the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) Consortium to examine age-related trajectories inferred from cross-sectional measures of the ventricles, the basal ganglia (caudate, putamen, pallidum, and nucleus accumbens), the thalamus, hippocampus and amygdala using magnetic resonance imaging data obtained from 18,605 individuals aged 3-90 years. All subcortical structure volumes were at their maximum value early in life. The volume of the basal ganglia showed a monotonic negative association with age thereafter; there was no significant association between age and the volumes of the thalamus, amygdala and the hippocampus (with some degree of decline in thalamus) until the sixth decade of life after which they also showed a steep negative association with age. The lateral ventricles showed continuous enlargement throughout the lifespan. Age was positively associated with inter-individual variability in the hippocampus and amygdala and the lateral ventricles. These results were robust to potential confounders and could be used to examine the functional significance of deviations from typical age-related morphometric patterns.
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http://dx.doi.org/10.1002/hbm.25320DOI Listing
February 2021

Reciprocal relationships between paternal psychological distress and child internalising and externalising difficulties from 3 to 14 years: a cross-lagged analysis.

Eur Child Adolesc Psychiatry 2020 Sep 17. Epub 2020 Sep 17.

Department of Psychology and Human Development, UCL Institute of Education, University College London, 25 Woburn Square, London, WC1H 0AA, UK.

Research shows that paternal psychological distress is associated with child emotional and behavioural difficulties. However, little is known about the direction of this association including whether it is bidirectional. The aim of this study was to explore the reciprocal relationships between paternal psychological distress and child emotional and behavioural problems longitudinally (at ages 3, 5, 7, 11 and 14 years) in a sample of 13,105 children (49% girls) who participated in the UK's Millennium Cohort Study (MCS), a large-scale, nationally representative, longitudinal survey. Four domains of child problems (emotional symptoms, peer relations, conduct problems and hyperactivity/inattention) were measured with the Strengths and Difficulties Questionnaire and paternal psychological distress was measured with the Kessler K-6 scale. Data were analysed using cross-lagged path models. At all ages, paternal psychological distress predicted both subsequent child emotional symptoms as well as peer problems. Paternal psychological distress at child's age 3 was related to more hyperactivity at age 5 and, at age 5, paternal psychological distress was associated with more conduct problems at age 7. At age 11, paternal distress was also related to age 14 conduct problems and hyperactivity. Child effects were fewer and were found mainly for behavioural problems. Notably, we found bidirectional links between paternal psychological distress and child peer difficulties, from 11 to 14 years. Paternal psychological distress appears to influence child behaviour more consistently than the converse. However, in early adolescence, there appears to be a reciprocal relationship between fathers' mental health problems and children's peer problems.
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http://dx.doi.org/10.1007/s00787-020-01642-0DOI Listing
September 2020

Distinct developmental trajectories of internalising and externalising symptoms in childhood: Links with mental health and risky behaviours in early adolescence.

J Affect Disord 2020 11 31;276:1052-1060. Epub 2020 Jul 31.

Department of Psychology and Human Development, UCL Institute of Education, University College London, 25 Woburn Square, London WC1H 0AA, UK.

Background: High or increasing trajectories of internalising and externalising symptoms in childhood are mutually re-enforcing and associated with poor emotional and behavioural outcomes in adolescence. This study sought to identify classes of children with similar trajectories of internalising and externalising symptoms after adjusting one domain's symptoms for the other's at the classification stage, and to relate them to emotional and behavioural outcomes in mid-adolescence.

Methods: We used growth mixture modelling to classify 16,844 members of the Millennium Cohort Study (baseline N=19,244) into distinct classes based on their trajectories, across ages 3,5,7 and 11 years, of internalising and externalising symptoms adjusted for one another. We examined the predictive ability of these classes for depression, self-harm, trouble with police and drug use among 11,134 children with available data at age 14.

Results: We identified four classes of children following distinct trajectories of 'pure' internalising and externalising symptoms. After adjustments for confounding, those with increasing or initially high yet decreasing levels of internalising symptomatology, and those with persistently high or increasing levels of externalising problems were at increased risk of depression in early adolescence. Having initially low yet increasing levels of internalising symptomatology was additionally associated with an increased risk of self-harm and drug use in early adolescence.

Limitations: We cannot ascertain whether our longitudinal typology of internalising and externalising symptoms holds for outcomes later in adolescence or adulthood.

Conclusions: Interventions aiming to prevent depression, drug use or self-harm in mid-adolescence may be more successful if they target children showing increasing internalising symptoms in the primary school years.
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http://dx.doi.org/10.1016/j.jad.2020.07.130DOI Listing
November 2020

Prenatal and childhood adversity and inflammation in children: A population-based longitudinal study.

Brain Behav Immun 2020 07 3;87:524-530. Epub 2020 Feb 3.

Division of Psychiatry, Faculty of Brain Sciences, University College London, UK.

Background: Stressful life events experienced during childhood and early prenatal development have been associated with inflammation during childhood. However, no study has considered these two exposures jointly, or has investigated the effect of their interaction.

Methods: In the Avon Longitudinal Study of Parents and Children, a general-population birth cohort, we explored if inflammatory markers [serum C-reactive protein (CRP) and interleukin 6 (IL-6)] at age 9 years were related to early prenatal events (at 18 weeks pregnancy), childhood events (measured on seven occasions at ages 0-9 years) and their interaction (n = 3,915). Latent growth curve modelling estimated trajectories of childhood events, and linear regression explored associations of prenatal and childhood events with inflammatory markers. Models controlled for ethnicity, socioeconomic status and body mass index, were stratified by gender and considered both unweighted and weighted (by impact) event exposures.

Results: Even after adjustment for confounders and prenatal events, both the intercept and the slope of number of childhood events were associated with IL-6, but only in females. The significant effect of the slope held for both weighted (by impact) and unweighted event specifications. Prenatal events were not associated with either inflammatory marker when childhood events were controlled. There was no evidence for synergistic effects of prenatal and childhood events.

Conclusion: Independently of prenatal adverse life events, the number and increase in number of adverse life events experienced in childhood were associated positively with plasma levels of inflammatory markers, such as IL-6, in girls. This gender specificity warrants further research.
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http://dx.doi.org/10.1016/j.bbi.2020.01.024DOI Listing
July 2020

Trajectories of physical activity from midlife to old age and associations with subsequent cardiovascular disease and all-cause mortality.

J Epidemiol Community Health 2020 02 8;74(2):130-136. Epub 2019 Nov 8.

Primary Care and Population Health, University College London, London, UK.

Introduction: It is well established that physical activity (PA) protects against mortality and morbidity, but how long-term patterns of PA are associated with mortality and cardiovascular disease (CVD) remains unclear.

Methods: 3231 men recruited to the British Regional Heart Study, a prospective cohort study, reported usual PA levels at baseline in 1978-1980 (aged 40-59 years) and at 12-year, 16-year and 20-year follow ups. Twenty-year trajectories of PA, spanning from 1978/1980 to 2000, were identified using group-based trajectory modelling. Men were subsequently followed up until 30 June 2016 for mortality through National Health Service central registers and for non-fatal CVD events through primary and secondary care records. Data analyses were conducted in 2019.

Results: Three PA trajectories were identified: low/decreasing (22.7%), light/stable (51.0%) and moderate/increasing (26.3%). Over a median follow-up of 16.4 years, there were 1735 deaths. Compared with the low/decreasing group, membership of the light/stable (HR 0.83, 95% CI 0.74 to 0.94) and moderate/increasing (HR 0.76, 95% CI 0.66 to 0.88) groups was associated with a lower risk of all-cause mortality. Similar associations were observed for CVD mortality, major coronary heart disease and all CVD events. Associations were only partially explained by a range of confounders. Sensitivity analyses suggested that survival benefits were largely driven by most recent/current PA.

Conclusions: A dose-response relationship was observed, with higher levels of PA from midlife to old age associated with additional benefits. However, even fairly modest and sustained PA was protective and may be more achievable for the most inactive.
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http://dx.doi.org/10.1136/jech-2019-212706DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6993021PMC
February 2020

The codevelopment of internalizing symptoms, externalizing symptoms, and cognitive ability across childhood and adolescence.

Dev Psychopathol 2020 10;32(4):1375-1389

Department of Psychology and Human Development, UCL Institute of Education, University College London, London, UK.

Cognitive ability, externalizing symptoms, and internalizing symptoms are correlated in children. However, it is not known why they combine in the general child population over time. To address this, we used data on 17,318 children participating in the UK Millennium Cohort Study and followed-up five times between ages 3 and 14 years. We fitted three parallel-process latent growth curve models to identify the parallel unfolding of children's trajectories of internalizing symptoms, externalizing symptoms, and cognitive ability across this period. We also examined the effects of time-invariant (ethnicity, birth weight, maternal education and age at birth, and breastfeeding status) and time-varying covariates (maternal psychological distress and socioeconomic disadvantage) on the growth parameters of the trajectories. The results showed that the intercepts of the trajectories of cognitive ability and, particularly, externalizing symptoms were inversely correlated. Their linear slopes were also inversely correlated, suggesting parallel development. Internalizing symptoms were correlated positively with externalizing symptoms and inversely (and more modestly) with cognitive ability at baseline, but the slope of internalizing symptoms correlated (positively) only with the slope of externalizing symptoms. The covariates predicted 9% to 41% of the variance in the intercepts and slopes of all domains, suggesting they are important common risk factors. Overall, it appears that externalizing symptoms develop in parallel with both cognitive ability and internalizing symptoms from early childhood through to middle adolescence. Children on an increasing trajectory of externalizing symptoms are likely both increasing in internalizing symptoms and decreasing in cognitive skills as well, and are thus an important group to target for intervention.
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http://dx.doi.org/10.1017/S0954579419001330DOI Listing
October 2020

The Role of Primary School Composition in the Trajectories of Internalising and Externalising Problems across Childhood and Adolescence.

J Abnorm Child Psychol 2020 02;48(2):197-211

Department of Psychology and Human Development, UCL Institute of Education, University College London, 25 Woburn Square, WC1H 0AA, London, UK.

There is little research on the role of school and its composition in explaining individual children's psychological outcomes. This study examined for the first time the role of several primary-school compositional characteristics, and their interactions with individual level characteristics, in the development of two such outcomes, internalising and externalising problems, at ages 7, 11 and 14 years in 4794 children in England participating in the Millennium Cohort Study. Using hierarchical (multilevel) linear models, we found that, even after adjusting for individual and family characteristics, children in schools with higher proportions of pupils eligible for free school meals had more externalising problems. In general, children with special educational needs, lower academic performance, more distressed mothers, and those in non-intact families had more internalising and externalising problems. Our results underline the importance of targeting schools with less affluent overall intakes, but also highlight the key role of individual and family characteristics in the development of their pupils' psychological functioning.
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http://dx.doi.org/10.1007/s10802-019-00584-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6969860PMC
February 2020

Correction to: Main and interactive effects of inflammation and perceived neighbourhood cohesion on psychological distress: results from a population-based study in the UK.

Qual Life Res 2019 Aug;28(8):2159

Department of Psychology and Human Development, UCL Institute of Education, University College London, 25 Woburn Square, London, WC1H 0AA, UK.

The article "Main and interactive effects of inflammation and perceived neighbourhood cohesion on psychological distress: results from a population-based study in the UK", written by "Efstathios Papachristou, Eirini Flouri, Theodora Kokosi and Marta Francesconi", was originally published electronically on the publisher's Internet portal (currently SpringerLink) on 25 February 2019 without open access.
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http://dx.doi.org/10.1007/s11136-019-02178-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6620368PMC
August 2019

Peer problems, bullying involvement, and affective decision-making in adolescence.

Br J Dev Psychol 2019 11 11;37(4):466-485. Epub 2019 Apr 11.

Department of Psychology and Human Development, UCL Institute of Education, University College London, UK.

We investigated, using a cross-lagged design, the longitudinal association of bullying involvement and peer problems with affective decision-making in adolescence (ages 11 and 14 years) in 13,888 participants of the Millennium Cohort Study. Affective decision-making (risk-taking, quality of decision-making, risk adjustment, deliberation time, and delay aversion) was measured with the Cambridge Gambling Task, bullying involvement (bully, bully-victim, victim, or 'neutral' status) with self-report measures, and peer problems with the parent-reported Strengths and Difficulties Questionnaire. In general, peer problems were associated with decision-making in the unadjusted model but not after controlling for confounding. However, bullying involvement was related to decision-making even after adjustment. Compared to 'neutral' males, bullies and bully-victims improved over time in risk adjustment, and bully-victims in deliberation time, too. In both sexes, bullies showed more risk-taking compared to their 'neutral' counterparts. It seems that bullies are more sensitive to reward (or less sensitive to punishment) than those not involved in bullying. The finding that male bullies show improvement in decision-making warrants further research. Statement of contribution What is already known on this subject? In adults, decision-making deficits and social exclusion or rejection are linked In youth, only two studies have explored this link with gambling tasks measuring real-world difficulties in decision-making. Both studies were cross-sectional and small-scale. What does this study add? We explore this link in adolescence, using a large, general population longitudinal sample and the Cambridge Gambling Task. Bullies were more sensitive to reward (or less sensitive to punishment) than those not involved in bullying. Male bullies improved over time in risk adjustment, a finding that warrants further research.
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http://dx.doi.org/10.1111/bjdp.12287DOI Listing
November 2019

Stressful life events, inflammation and emotional and behavioural problems in children: A population-based study.

Brain Behav Immun 2019 08 23;80:66-72. Epub 2019 Feb 23.

Division of Psychiatry, Faculty of Brain Sciences, University College London, UK.

Objective: To test the hypothesis that higher plasma levels of inflammatory markers due to exposure to adverse life events may lead to internalising and externalising symptoms in children.

Method: Using data from the Avon Longitudinal Study of Parents and Children, a general population birth cohort, we explored if inflammatory markers [serum C-reactive protein (CRP) and interleukin-6 (IL-6)] at age 9 years explain the longitudinal association between adverse life events (at ages 1-9 and 9-11 years) and internalising and externalising symptoms (at ages 9 and 11 years). Data (n = 4583) were analysed using cross-lagged panel modelling to take into account reciprocal associations and reverse causality, and path analyses to test for mediation. Gender, ethnicity, body mass index, maternal education, paternal social class and maternal depression were used as potential confounders.

Results: CRP was not associated with adverse life events. There was evidence for partial mediation by IL-6 such that exposure to adverse life events was associated with increased levels of IL-6 later, in turn associated with later internalising symptoms. These associations were robust to adjustment for confounders. IL-6 did not explain part of the opposite association, that of earlier internalising symptoms and later life events, nor did it explain either direction of the association between life events and externalising symptoms.

Conclusion: Our findings suggest a pathway that may connect early psychosocial adversity and childhood internalising symptoms via higher plasma levels of inflammatory markers, such as IL-6.
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http://dx.doi.org/10.1016/j.bbi.2019.02.023DOI Listing
August 2019

Main and interactive effects of inflammation and perceived neighbourhood cohesion on psychological distress: results from a population-based study in the UK.

Qual Life Res 2019 Aug 25;28(8):2147-2157. Epub 2019 Feb 25.

Department of Psychology and Human Development, UCL Institute of Education, University College London, 25 Woburn Square, London, WC1H 0AA, UK.

Purpose: Low neighbourhood cohesion and increased levels of inflammation are independent predictors of psychological distress. In this study we explored if they also interact to predict it.

Methods: Our sample was 9,393 adult participants of the UK Household Longitudinal Study (UKHLS), a large longitudinal household panel study in the UK. Inflammation was measured using C-reactive protein levels. Perceived neighbourhood cohesion was measured using a 13-item questionnaire. Psychological distress was measured with the General Health Questionnaire-12.

Results: Perceived neighbourhood cohesion and inflammation retained their significant main effects on psychological distress even after adjustment for confounders (age, gender, ethnicity, partner status, education, smoking status, obesity and urbanicity). The effect of neighbourhood cohesion was larger. However, we did not find evidence for an interactive association between the two.

Conclusions: Perceived neighbourhood cohesion was inversely related to psychological distress, over and above other important person- and neighbourhood-level characteristics. Inflammation was also associated with psychological distress, albeit less strongly. If these associations are causal, they suggest that promoting neighbourhood cohesion can alleviate some of the burden associated with psychological distress.
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http://dx.doi.org/10.1007/s11136-019-02143-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6620256PMC
August 2019

Developmental cascades of internalising symptoms, externalising problems and cognitive ability from early childhood to middle adolescence.

Eur Psychiatry 2019 04 21;57:61-69. Epub 2019 Jan 21.

Centre for Longitudinal Studies, UCL Institute of Education, 55-59 Gordon Square, WC1H 0NU, London, UK.

Background: Cognitive ability and problem behaviour (externalising and internalising problems) are variable and inter-related in children. However, it is not known if they mutually influence one another, if difficulties in one cause difficulties in the other, or if they are related only because they share causes.

Methods: Random-intercept cross-lagged models adjusted for confounding were fitted to explore this in 17,318 (51% male) children of the UK's Millennium Cohort Study at ages 3, 5, 7, 11 and 14 years. Externalising and internalising problems were assessed using the parent-reported Strengths and Difficulties Questionnaire. Cognitive ability was measured using standardised scores of age-appropriate validated cognitive ability assessments. Where multiple cognitive assessments were available a single score was derived using principal components analysis.

Results: There was much evidence for cross-domain longitudinal effects in childhood, especially for cognitive ability (on both internalising and externalising problems and in both males and females) and externalising problems (on internalising problems in both genders and cognitive ability in males). Bidirectional effects were childhood-limited, gender-specific and less consistent. The consistent bidirectional associations were, in males, between externalising problems and cognitive ability, and, in females, between externalising and internalising problems (although the effects of internalising problems were weak). In adolescence, only externalising problems had cross-domain effects such that, in both genders, they were associated with lower cognitive ability in subsequent measurements and increased levels of internalising problems.

Conclusions: In either childhood or adolescence, reducing behavioural problems could have both emotional and cognitive benefits. In childhood, improving cognitive skills could reduce both emotional and behavioural problems.
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http://dx.doi.org/10.1016/j.eurpsy.2018.12.005DOI Listing
April 2019

Physical frailty in older men: prospective associations with diet quality and patterns.

Age Ageing 2019 05;48(3):355-360

UCL Department of Primary Care & Population Health, UCL Medical School, Rowland Hill Street, London, UK.

Background: increasing numbers of older adults are living with frailty and its adverse consequences. We investigated relationships between diet quality or patterns and incident physical frailty in older British men and whether any associations were influenced by inflammation.

Methods: prospective study of 945 men from the British Regional Heart Study aged 70-92 years with no prevalent frailty. Incident frailty was assessed by questionnaire after 3 years of follow-up. Frailty was defined as having at least three of: low grip strength, low physical activity, slow walking speed, unintentional weight loss and feeling of low energy, all based on self-report. The Healthy Diet Indicator (HDI) based on WHO dietary guidelines and the Elderly Dietary Index (EDI) based on a Mediterranean-style dietary intake were computed from questionnaire data and three dietary patterns were identified using principal components analysis: prudent, high fat/low fibre and high sugar.

Results: men in the highest EDI category and those who followed a prudent diet were less likely to become frail [top vs bottom category odds ratio (OR) (95% CI) 0.49 (0.30, 0.82) and 0.53 (0.30, 0.92) respectively] after adjustment for potential confounders including BMI and prevalent cardiovascular disease. No significant association was seen for the HDI. By contrast those who had a high fat low fibre diet pattern were more likely to become frail [OR (95% CI) 2.54 (1.46, 4.40)]. These associations were not mediated by C-reactive protein (marker of inflammation).

Conclusions: the findings suggest adherence to a Mediterranean-style diet is associated with reduced risk of developing frailty in older people.
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http://dx.doi.org/10.1093/ageing/afy216DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6503938PMC
May 2019

Twenty-Year Trajectories of Physical Activity Types from Midlife to Old Age.

Med Sci Sports Exerc 2019 03;51(3):481-489

UCL Department of Primary Care & Population Health, UCL Medical School, Rowland Hill Street, London, UNITED KINGDOM.

Purpose: Correlates of physical activity (PA) vary according to type. However, predictors of long-term patterns of PA types into old age are unknown. This study aimed to identify 20-yr trajectories of PA types into old age and their predictors.

Methods: Seven thousand seven hundred thirty-five men (age, 40-59 yr) recruited from UK towns in 1978 to 1980 were followed up after 12, 16, and 20 yr. Men reported participation in sport/exercise, recreational activity and walking, health status, lifestyle behaviors and socio-demographic characteristics. Group-based trajectory modeling identified the trajectories of PA types and associations with time-stable and time-varying covariates.

Results: Men with ≥3 measures of sport/exercise (n = 5116), recreational activity (n = 5085) and walking (n = 5106) respectively were included in analyses. Three trajectory groups were identified for sport/exercise, four for recreational activity and three for walking. Poor health, obesity and smoking were associated with reduced odds of following a more favorable trajectory for all PA types. A range of socioeconomic, regional and lifestyle factors were also associated with PA trajectories but the magnitude and direction were specific to PA type. For example, men with manual occupations were less likely to follow a favorable sport/exercise trajectory but more likely to follow an increasing walking trajectory compared to men with nonmanual occupations. Retirement was associated with increased PA but this was largely due to increased sport/exercise participation.

Conclusions: Physical activity trajectories from middle to old age vary by activity type. The predictors of these trajectories and effects of major life events, such as retirement, are also specific to the type of PA.
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http://dx.doi.org/10.1249/MSS.0000000000001802DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6354913PMC
March 2019

The role of neighbourhood greenspace in children's spatial working memory.

Br J Educ Psychol 2019 Jun 5;89(2):359-373. Epub 2018 Sep 5.

Department of Psychology and Human Development, UCL Institute of Education, University College London, UK.

Background: Exposure to nature may be particularly beneficial for the brain regions that support spatial working memory, a strong correlate of academic achievement.

Aims: To explore whether children living in greener neighbourhoods (wards) have better spatial working memory.

Sample: Drawn from the UK's Millennium Cohort Study, the sample was 4,758 11-year-olds living in urban areas in England.

Methods: We fitted two-level regression models, with children nested in wards, before and after adjustment for confounders, including poverty, parental education, sports participation, neighbourhood deprivation, and neighbourhood history. Spatial working memory was measured using the Cambridge Neuropsychological Test Automated Battery Spatial Working Memory task. Greenspace was measured as the percentage of greenery in the child's ward.

Results: Even after controlling for confounders, lower quantity of neighbourhood greenspace was related to poorer spatial working memory. Importantly, neighbourhood deprivation did not modify this relationship. Therefore, lower quantity of greenspace was related to poorer spatial working memory similarly in deprived and non-deprived neighbourhoods.

Conclusions: Children living in greener urban neighbourhoods have better spatial working memory. If this association is causal, then our findings can be used to inform policy decisions about both education and urban planning.
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http://dx.doi.org/10.1111/bjep.12243DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6563484PMC
June 2019

Association Between 20-Year Trajectories of Nonoccupational Physical Activity From Midlife to Old Age and Biomarkers of Cardiovascular Disease: A 20-Year Longitudinal Study of British Men.

Am J Epidemiol 2018 11;187(11):2315-2323

Department of Primary Care and Population Health, University College London, London, United Kingdom.

The trajectories of physical activity (PA) from midlife into old age and their associations with established and novel cardiovascular disease (CVD) risk factors in later life remain unclear. This study examined associations between 20-year nonoccupational PA trajectories and a range of CVD biomarkers at ages 60-79 years. We used data from a sample of 3,331 men (mean baseline age = 50.2 ± 5.8 years) recruited in 1978-1980, with follow-up after 12, 16, and 20 years, reporting habitual nonoccupational PA at each wave. At the 20-year follow-up, surviving men attended a physical examination and provided a fasting blood sample. Group-based trajectory modeling was used to identify trajectories. Adjusted regression analyses examined the association between trajectory-group membership and several cardiometabolic, cardiac, and inflammatory markers at follow-up. Three distinct 20-year trajectories were identified: low/decreasing (21.3%), light/stable (51.8%), and moderate/increasing (27.0%). Compared with the low/decreasing group, membership in the light/stable and moderate/increasing trajectory groups was associated with a more favorable cardiometabolic profile and lower levels of inflammation and endothelial dysfunction. Although following a moderate-increasing PA trajectory was most favorable, more modest but sustained doses of PA into old age may be sufficient to lower CVD risk.
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http://dx.doi.org/10.1093/aje/kwy157DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6211233PMC
November 2018

Healthier diet quality and dietary patterns are associated with lower risk of mobility limitation in older men.

Eur J Nutr 2019 Sep 23;58(6):2335-2343. Epub 2018 Jul 23.

UCL Department of Primary Care and Population Health, UCL Medical School, Rowland Hill Street, London, NW3 2PF, UK.

Purpose: To investigate associations between diet quality, dietary patterns and mobility limitation 15 years later in a population-based sample of older British men.

Methods: We used longitudinal data from 1234 men from the British Regional Heart Study, mean age 66 years at baseline. Mobility limitation was defined as difficulty going up- or downstairs or walking 400 yards as a result of a long-term health problem. Dietary intake was measured using a food frequency questionnaire data from which the Healthy Diet Indicator (HDI), the Elderly Dietary Index (EDI), and three a posteriori dietary patterns were derived. The a posteriori dietary patterns were identified using principal components analysis: (1) high fat/low fibre, (2) prudent and (3) high sugar.

Results: Men with greater adherence to the EDI or HDI were less likely to have mobility limitation at follow-up, top vs bottom category odds ratio for the EDI OR 0.50, 95% CI 0.34, 0.75, and for the HDI OR 0.55, 95% CI 0.35, 0.85, after adjusting for age, social class, region of residence, smoking, alcohol consumption and energy intake. Men with a higher score for the high-fat/low-fibre pattern at baseline were more likely to have mobility limitation at follow-up, top vs bottom quartile odds ratio OR 3.28 95% CI 2.05, 5.24. These associations were little changed by adjusting for BMI and physical activity.

Conclusion: Our study provides evidence that healthier eating patterns could contribute to prevention or delay of mobility limitation in older British men.
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http://dx.doi.org/10.1007/s00394-018-1786-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6689276PMC
September 2019

Socioeconomic disadvantage across the life-course and oral health in older age: findings from a longitudinal study of older British men.

J Public Health (Oxf) 2018 12;40(4):e423-e430

Institute of Epidemiology and Health Care, UCL, London, UK.

Background: The influence of life-course socioeconomic disadvantage on oral health at older ages is not well-established. We examined the influence of socioeconomic factors in childhood, middle-age and older age on oral health at older ages, and tested conceptual life-course models (sensitive period, accumulation of risk, social mobility) to determine which best described observed associations.

Methods: A representative cohort of British men aged 71-92 in 2010-12 included socioeconomic factors in childhood, middle-age and older age. Oral health assessment at 71-92 years (n = 1622) included tooth count, periodontal disease and self-rated oral health (excellent/good, fair/poor) (n = 2147). Life-course models (adjusted for age and town of residence) were compared with a saturated model using Likelihood-ratio tests.

Results: Socioeconomic disadvantage in childhood, middle-age and older age was associated with complete tooth loss at 71-92 years-age and town adjusted odds ratios (95% CI) were 1.39 (1.02-1.90), 2.26 (1.70-3.01), 1.83 (1.35-2.49), respectively. Socioeconomic disadvantage in childhood and middle-age was associated with poor self-rated oral health; adjusted odds ratios (95% CI) were 1.48 (1.19-1.85) and 1.45 (1.18-1.78), respectively. A sensitive period for socioeconomic disadvantage in middle-age provided the best model fit for tooth loss, while accumulation of risk model was the strongest for poor self-rated oral health. None of the life-course models were significant for periodontal disease measures.

Conclusion: Socioeconomic disadvantage in middle-age has a particularly strong influence on tooth loss in older age. Poor self-rated oral health in older age is influenced by socioeconomic disadvantage across the life-course. Addressing socioeconomic factors in middle and older ages are likely to be important for better oral health in later life.
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http://dx.doi.org/10.1093/pubmed/fdy068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6540288PMC
December 2018

Early adolescent outcomes of joint developmental trajectories of problem behavior and IQ in childhood.

Eur Child Adolesc Psychiatry 2018 Dec 16;27(12):1595-1605. Epub 2018 Apr 16.

UCL Division of Psychiatry, University College London, London, UK.

General cognitive ability (IQ) and problem behavior (externalizing and internalizing problems) are variable and inter-related in children. However, it is unknown how they co-develop in the general child population and how their patterns of co-development may be related to later outcomes. We carried out this study to explore this. Using data from 16,844 Millennium Cohort Study children, we fitted three-parallel-process growth mixture models to identify joint developmental trajectories of internalizing, externalizing and IQ scores at ages 3-11 years. We then examined their associations with age 11 outcomes. We identified a typically developing group (83%) and three atypical groups, all with worse behavior and ability: children with improving behavior and low (but improving in males) ability (6%); children with persistently high levels of problems and low ability (5%); and children with worsening behavior and low ability (6%). Compared to typically developing children, the latter two groups were more likely to show poor decision-making, be bullies or bully victims, engage in antisocial behaviors, skip and dislike school, be unhappy and have low self-esteem. By contrast, children (especially males) in the improver group had outcomes that were similar to, or even better than, those of their typically developing peers. These findings encourage the development of interventions to target children with both cognitive and behavioral difficulties.
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http://dx.doi.org/10.1007/s00787-018-1155-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6245124PMC
December 2018

Trajectories of self-reported physical activity and predictors during the transition to old age: a 20-year cohort study of British men.

Int J Behav Nutr Phys Act 2018 02 7;15(1):14. Epub 2018 Feb 7.

UCL Department of Primary Care & Population Health, Institute of Epidemiology and Health Care, UCL Medical School, Rowland Hill Street, London, NW3 2PF, UK.

Background: Maintenance of physical activity (PA) during later life is associated with optimal health; however, the long-term trajectories of PA into old age and their predictors have not been extensively researched using latent class methods. This study aimed to identify trajectories of self-reported PA and their predictors in men transitioning from midlife to old age.

Methods: 7735 men (aged 40-59 years) recruited in 1978-80 were followed up after 12, 16 and 20 years, reporting PA, health status, lifestyle behaviours and socio-demographic characteristics. Group-based trajectory modelling identified the trajectories of PA and associations with time-stable and time-varying covariates. We considered a range of sociodemographic and health and lifestyle factors as potential covariates.

Results: 4952 men (mean baseline age 49.1 ± 5.6 years) providing PA data at ≥3 time points were included in analyses. Three distinct 20-year trajectories were identified: low decreasing (24.6%, n = 1218), light stable (51.1%, n = 2530) and moderate increasing (24.3%, n = 1204). Being older, having a manual occupation, having never married or had children, residing in the midlands or North of England, suffering from a range of health conditions, being a smoker/ex-smoker and never consuming breakfast cereal or alcohol were independently associated with reduced odds of belonging to the moderate increasing trajectory group compared to the low decreasing group. Of the time-varying covariates considered, leaving employment was associated with a decrease in PA in the low decreasing group (β -0.306, p < 0.001) but an increase in the light stable (β 0.324, p < 0.001) and moderate increasing groups (β 0.847, p < 0.001). Developing cardiovascular-related conditions was associated with a decrease in PA in the low decreasing (β -0.408, p < 0.001) and light stable groups (β -0.118, p < 0.001) but no association was observed in the moderate increasing group (β -0.060, p = 0.313).

Conclusions: Three distinct trajectories of PA were identified in men transitioning from midlife to old age, of which nearly a quarter had persistently low levels of PA. Promotion efforts may need to focus attention prior to middle age and consider a number of sociodemographic, health and lifestyle factors to sustain PA into old age. The effects of retirement and development of cardiovascular disease may vary according to PA trajectories.
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http://dx.doi.org/10.1186/s12966-017-0642-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803992PMC
February 2018

Influence of Poor Oral Health on Physical Frailty: A Population-Based Cohort Study of Older British Men.

J Am Geriatr Soc 2018 03 20;66(3):473-479. Epub 2017 Dec 20.

Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College of London, London, United Kingdom.

Objectives: To investigate the associations between objective and subjective measures of oral health and incident physical frailty.

Design: Cross-sectional and longitudinal study with 3 years of follow-up using data from the British Regional Heart Study.

Setting: General practices in 24 British towns.

Participants: Community-dwelling men aged 71 to 92 (N = 1,622).

Measurements: Objective assessments of oral health included tooth count and periodontal disease. Self-reported oral health measures included overall self-rated oral health; dry mouth symptoms; sensitivity to hot, cold, and sweet; and perceived difficulty eating. Frailty was defined using the Fried phenotype as having 3 or more of weight loss, grip strength, exhaustion, slow walking speed, and low physical activity. Incident frailty was assessed after 3 years of follow-up in 2014.

Results: Three hundred three (19%) men were frail at baseline (aged 71-92). Having fewer than 21 teeth, complete tooth loss, fair to poor self-rated oral health, difficulty eating, dry mouth, and more oral health problems were associated with greater likelihood of being frail. Of 1,284 men followed for 3 years, 107 (10%) became frail. The risk of incident frailty was higher in participants who were edentulous (odds ratio (OR) = 1.90, 95% confidence interval (CI) = 1.03-3.52); had 3 or more dry mouth symptoms (OR = 2.03, 95% CI = 1.18-3.48); and had 1 (OR = 2.34, 95% CI = 1.18-4.64), 2 (OR = 2.30, 95% CI = 1.09-4.84), or 3 or more (OR = 2.72, 95% CI = 1.11-6.64) oral health problems after adjustment for age, smoking, social class, history of cardiovascular disease or diabetes mellitus, and medications related to dry mouth.

Conclusion: The presence of oral health problems was associated with greater risks of being frail and developing frailty in older age. The identification and management of poor oral health in older people could be important in preventing frailty.
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http://dx.doi.org/10.1111/jgs.15175DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5887899PMC
March 2018

Self-reported vision impairment and incident prefrailty and frailty in English community-dwelling older adults: findings from a 4-year follow-up study.

J Epidemiol Community Health 2017 Nov 10;71(11):1053-1058. Epub 2017 Aug 10.

Department of Primary Care and Population Health, University College London, London, UK.

Background: Little is known about vision impairment and frailty in older age. We investigated the relationship of poor vision and incident prefrailty and frailty.

Methods: Cross-sectional and longitudinal analyses with 4-year follow-up of 2836 English community-dwellers aged ≥60 years. Vision impairment was defined as poor self-reported vision. A score of 0 out of the 5 Fried phenotype components was defined as non-frail, 1-2 prefrail and ≥3 as frail. Participants non-frail at baseline were followed-up for incident prefrailty and frailty. Participants prefrail at baseline were followed-up for incident frailty.

Results: 49% of participants (n=1396) were non-frail, 42% (n=1178) prefrail and 9% (n=262) frail. At follow-up, there were 367 new cases of prefrailty and frailty among those non-frail at baseline, and 133 new cases of frailty among those prefrail at baseline. In cross-sectional analysis, vision impairment was associated with frailty (age-adjustedandsex-adjusted OR 2.53, 95% CI 1.95 to 3.30). The association remained after further adjustment for wealth, education, cardiovascular disease, diabetes, falls, cognition and depression. In longitudinal analysis, compared with non-frail participants with no vision impairment, non-frail participants with vision impairment had twofold increased risks of prefrailty or frailty at follow-up (OR 2.07, 95% CI 1.32 to 3.24). The association remained after further adjustment. Prefrail participants with vision impairment did not have greater risks of becoming frail at follow-up.

Conclusion: Non-frail older adults who experience poor vision have increased risks of becoming prefrail and frail over 4 years. This is of public health importance as both vision impairment and frailty affect a large number of older adults.
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http://dx.doi.org/10.1136/jech-2017-209207DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5847099PMC
November 2017

The predictive value of childhood subthreshold manic symptoms for adolescent and adult psychiatric outcomes.

J Affect Disord 2017 Apr 24;212:86-92. Epub 2017 Jan 24.

Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA; Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, USA.

Background: Childhood subthreshold manic symptoms may represent a state of developmental vulnerability to Bipolar Disorder (BD) and may also be associated with other adverse psychiatric outcomes. To test this hypothesis we examined the structure and predictive value of childhood subthreshold manic symptoms for common psychiatric disorders presenting by early adulthood.

Methods: Subthreshold manic symptoms at age 11 years and lifetime clinical outcomes by age 19 years were ascertained in the TRacking Adolescents' Individual Lives Survey (TRAILS), a prospective Dutch community cohort. We used latent class analysis to identify subthreshold manic symptom profiles at baseline. The association between class membership and subsequent clinical diagnoses of BD (comprising BD-I, BD-II, mania and hypomania), depressive, anxiety and substance abuse disorders was determined using Cox proportional-hazard ratio (HR) models.

Results: At age 11 years, we identified a normative (n=916; 47%), a mildly symptomatic (n=843; 43%) and a highly symptomatic class (n=198; 10%). Referenced to the normative class, the sex- and age-adjusted risk of new-onset BD by the age of 19 years was significantly increased in the mildly (HR=2.01, 95%CI 1.13-3.59) and highly symptomatic classes (HR=5.02, 95%CI 2.48-10.16). These estimates remained significant after further adjustments for cognitive and family function, parental socioeconomic status, parental psychiatric morbidity, and comorbid disorders at baseline (p-value for linear trend across classes<0.01). Class membership did not show significant associations with incident depressive, anxiety and substance abuse disorders in the fully adjusted regression models.

Limitations: The period of risk for adult-onset BD extends beyond the observational period of the study.

Conclusions: Elevated childhood subthreshold manic symptoms are associated with increased risk of BD by early adulthood and are therefore a potentially useful phenotype for the early identification of at-risk individuals.
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http://dx.doi.org/10.1016/j.jad.2017.01.038DOI Listing
April 2017

Self-Reported Hearing Impairment and Incident Frailty in English Community-Dwelling Older Adults: A 4-Year Follow-Up Study.

J Am Geriatr Soc 2017 May 19;65(5):958-965. Epub 2016 Dec 19.

Department of Primary Care and Population Health, University College London, London, United Kingdom.

Objectives: To examine the association between hearing impairment and incident frailty in older adults.

Design: Cross-sectional and longitudinal analyses with 4-year follow-up using data from the English Longitudinal Study of Ageing.

Setting: Community.

Participants: Community-dwelling individuals aged 60 and older with data on hearing and frailty status (N = 2,836).

Measurements: Hearing impairment was defined as poor self-reported hearing. Having none of the five Fried frailty phenotype components (slow walking, weak grip, self-reported exhaustion, weight loss and low physical activity) was defined as not frail, having one or two as prefrail, and having three or more as frail. Participants who were not frail at baseline were followed for incident prefrailty and frailty. Participants who were prefrail at baseline were followed for incident frailty.

Results: One thousand three hundred ninety six (49%) participants were not frail, 1,178 (42%) were prefrail, and 262 (9%) were frail according to the Fried phenotype. At follow-up, there were 367 new cases of prefrailty and frailty among those who were not frail at baseline (n = 1,396) and 133 new cases of frailty among those who were prefrail at baseline (n = 1,178). Cross-sectional analysis showed an association between hearing impairment and frailty (age- and sex-adjusted odds ratio (OR) = 1.66, 95% confidence interval (CI) = 1.37-2.01), which remained after further adjustments for wealth, education, cardiovascular disease, cognition, and depression. In longitudinal analyses, nonfrail participants with hearing impairment were at greater risk of becoming prefrail and frail at follow-up (OR = 1.43, 95% CI = 1.05-1.95), but the association was attenuated after further adjustment. Prefrail participants with hearing impairment had a greater risk of becoming frail at follow-up (OR = 1.64, 95% CI = 1.07-2.51) even after further adjustment.

Conclusion: Hearing impairment in prefrail older adults was associated with greater risk of becoming frail, independent of covariates, suggesting that hearing impairment may hasten the progression of frailty.
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http://dx.doi.org/10.1111/jgs.14687DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5484326PMC
May 2017

Ability of Self-Reported Frailty Components to Predict Incident Disability, Falls, and All-Cause Mortality: Results From a Population-Based Study of Older British Men.

J Am Med Dir Assoc 2017 Feb 11;18(2):152-157. Epub 2016 Oct 11.

Department of Primary Care and Population Health, UCL Medical School, London, United Kingdom.

Background: Frailty is a state of increased vulnerability to disability, falls, and mortality. The Fried frailty phenotype includes assessments of grip strength and gait speed, which are complex or require objective measurements and are challenging in routine primary care practice. In this study, we aimed to develop a simple assessment tool based on self-reported information on the 5 Fried frailty components to identify older people at risk of incident disability, falls, and mortality.

Methods: Analyses are based on a prospective cohort comprising older British men aged 71-92 years in 2010-2012. A follow-up questionnaire was completed in 2014. The discriminatory power for incident disability and falls was compared with the Fried frailty phenotype using receiver operating characteristic-area under the curve (ROC-AUC); for incident falls it was additionally compared with the FRAIL scale (fatigue, resistance, ambulation, illnesses, and loss of weight). Predictive ability for mortality was assessed using age-adjusted Cox proportional hazard models.

Results: A model including self-reported measures of slow walking speed, low physical activity, and exhaustion had a significantly increased ROC-AUC [0.68, 95% confidence interval (CI) 0.63-0.72] for incident disability compared with the Fried frailty phenotype (0.63, 95% CI 0.59-0.68; P value of ΔAUC = .003). A second model including self-reported measures of slow walking speed, low physical activity, and weight loss had a higher ROC-AUC (0.64, 95% CI 0.59-0.68) for incident falls compared with the Fried frailty phenotype (0.57, 95% CI 0.53-0.61; P value of ΔAUC < .001) and the FRAIL scale (0.56, 95% CI 0.52-0.61; P value of ΔAUC = .001). This model was also associated with an increased risk of mortality (Harrell's C = 0.73, Somer's D = 0.45; linear trend P < .001) compared with the Fried phenotype (Harrell's C = 0.71; Somer's D = 0.42; linear trend P < .001) and the FRAIL scale (Harrell's C = 0.71, Somer's D = 0.42; linear trend P < .001).

Conclusions: Self-reported information on the Fried frailty components had superior discriminatory and predictive ability compared with the Fried frailty phenotype for all the adverse outcomes considered and with the FRAIL scale for incident falls and mortality. These findings have important implications for developing interventions and health care policies as they offer a simple way to identify older people at risk of adverse outcomes associated with frailty.
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http://dx.doi.org/10.1016/j.jamda.2016.08.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5270459PMC
February 2017

Comparative Evaluation of Child Behavior Checklist-Derived Scales in Children Clinically Referred for Emotional and Behavioral Dysregulation.

Front Psychiatry 2016 24;7:146. Epub 2016 Aug 24.

Department of Psychiatry, Icahn School of Medicine at Mount Sinai , New York, NY , USA.

Background: We recently developed the Child Behavior Checklist-Mania Scale (CBCL-MS), a novel and short instrument for the assessment of mania-like symptoms in children and adolescents derived from the CBCL item pool and have demonstrated its construct validity and temporal stability in a longitudinal general population sample.

Objective: The aim of this study was to evaluate the construct validity of the 19-item CBCL-MS in a clinical sample and to compare its discriminatory ability to that of the 40-item CBCL-dysregulation profile (CBCL-DP) and the 34-item CBCL-Externalizing Scale.

Methods: The study sample comprised 202 children, aged 7-12 years, diagnosed with DSM-defined attention deficit hyperactivity disorder (ADHD), conduct disorder (CD), oppositional defiant disorder (ODD), and mood and anxiety disorders based on the Diagnostic Interview Schedule for Children. The construct validity of the CBCL-MS was tested by means of a confirmatory factor analysis. Receiver operating characteristics (ROC) curves and logistic regression analyses adjusted for sex and age were used to assess the discriminatory ability relative to that of the CBCL-DP and the CBCL-Externalizing Scale.

Results: The CBCL-MS had excellent construct validity (comparative fit index = 0.97; Tucker-Lewis index = 0.96; root mean square error of approximation = 0.04). Despite similar overall performance across scales, the clinical range scores of the CBCL-DP and the CBCL-Externalizing Scale were associated with higher odds for ODD and CD, while the clinical range scores of the CBCL-MS were associated with higher odds for mood disorders. The concordance rate among the children who scored within the clinical range of each scale was over 90%.

Conclusion: CBCL-MS has good construct validity in general population and clinical samples and is therefore suitable for both clinical practice and research.
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http://dx.doi.org/10.3389/fpsyt.2016.00146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4995201PMC
September 2016

The relationships between body composition characteristics and cognitive functioning in a population-based sample of older British men.

BMC Geriatr 2015 Dec 21;15:172. Epub 2015 Dec 21.

Department of Primary Care & Population Health, UCL Medical School, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.

Background: Current research has established obesity as one of the main modifiable risk factors for cognitive impairment. However, evidence on the relationships of total and regional body composition measures as well as sarcopenia with cognitive functioning in the older population remains inconsistent.

Methods: Data are based on 1,570 participants from the British Regional Heart Study (BRHS), a cohort of older British men from 24 British towns initiated in 1978-80, who were re-examined in 2010-12, aged 71-92 years. Cognitive functioning was assessed with the Test-Your-Memory cognitive screening tool. Body composition characteristics assessed using bioelectrical impedance analysis included total fat mass (FM), central FM, peripheral FM, and visceral fat level. Sarcopenia was defined using the European Working Group on Sarcopenia in Older People (EWGSOP) definition of severe sarcopenia and the Foundation for the National Institutes of Health (FNIH) sarcopenia project criteria.

Results: Among 1,570 men, 636 (41 %) were classified in the mild cognitive impairment (MCI) and 133 (8 %) in the severe cognitive impairment (SCI) groups. Age-adjusted multinomial logistic regressions showed that compared with participants in the normal cognitive ageing group, those with SCI were more likely to have waist circumference >102 cm, BMI >30 kg/m(2), to be in the upper quintile of total FM, central FM, peripheral FM and visceral fat level and to be sarcopenic. The relationships remained significant for total FM (RR = 2.16, 95 % CI 1.29-3.63), central FM (RR = 1.85, 95 % CI 1.09-3.14), peripheral FM (RR = 2.67, 95 % CI 1.59-4.48), visceral fat level (RR = 2.28, 95 % CI 1.32-3.94), BMI (RR = 2.25, 95 % CI 1.36-3.72) and waist circumference (RR = 1.63, 95 % CI 1.05-2.55) after adjustments for alcohol, smoking, social class, physical activity and history of cardiovascular diseases or diabetes. After further adjustments for interleukin-6 and insulin resistance, central FM, waist circumference and sarcopenia were no longer significantly associated with SCI.

Conclusions: Increased levels of peripheral FM, visceral fat level, and BMI are associated with SCI among older people. Distinct pathophysiological mechanisms link regional adipose tissue deposition and cognitive functioning.
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http://dx.doi.org/10.1186/s12877-015-0169-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4687114PMC
December 2015

The Test Your Memory cognitive screening tool: sociodemographic and cardiometabolic risk correlates in a population-based study of older British men.

Int J Geriatr Psychiatry 2016 Jun 21;31(6):666-75. Epub 2015 Oct 21.

Department of Primary Care and Population Health, UCL, London, UK.

Objective: This study aimed to examine the association of Test Your Memory (TYM)-defined cognitive impairment groups with known sociodemographic and cardiometabolic correlates of cognitive impairment in a population-based study of older adults.

Methods: Participants were members of the British Regional Heart Study, a cohort across 24 British towns initiated in 1978-1980. Data stemmed from 1570 British men examined in 2010-2012, aged 71-92 years. Sociodemographic and cardiometabolic factors were compared between participants defined as having TYM scores in the normal cognitive ageing, mild cognitive impairment (MCI) and severe cognitive impairment (SCI) groups, defined as ≥46 (45 if ≥80 years of age), ≥33 and <33, respectively.

Results: Among 1570 men, 636 (41%) were classified in the MCI and 133 (8%) in the SCI groups. Compared with participants in the normal cognitive ageing category, individuals with SCI were characterized primarily by lower socio-economic position (odds ratio (OR) = 6.15, 95% confidence interval (CI) 4.00-9.46), slower average walking speed (OR = 3.36, 95% CI 2.21-5.10), mobility problems (OR = 4.61, 95% CI 3.04-6.97), poorer self-reported overall health (OR = 2.63, 95% CI 1.79-3.87), obesity (OR = 2.59, 95% CI 1.72-3.91) and impaired lung function (OR = 2.25, 95% CI 1.47-3.45). A similar albeit slightly weaker pattern was observed for participants with MCI.

Conclusion: Sociodemographic and lifestyle factors as well as adiposity measures, lung function and poor overall health are associated with cognitive impairments in late life. The correlates of cognitive abilities in the MCI and SCI groups, as defined by the TYM, resemble the risk profile for MCI and Alzheimer's disease outlined in current epidemiological models.
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http://dx.doi.org/10.1002/gps.4377DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4855642PMC
June 2016
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