Publications by authors named "Kaarin J Anstey"

353 Publications

Social Cognition and Social Functioning in MCI and Dementia in an Epidemiological Sample.

J Int Neuropsychol Soc 2021 Sep 6:1-12. Epub 2021 Sep 6.

School of Psychology, University of New South Wales, Sydney, Australia.

Objective: Social cognition is impaired in mild cognitive impairment (MCI) and dementia. However, its relationship to social functioning and perceived social support has yet to be explored. Here, we examine how theory of mind (ToM) relates to social functioning in MCI and dementia.

Methods: Older adults (cognitively normal = 1272; MCI = 132; dementia = 23) from the PATH Through Life project, a longitudinal, population-based study, were assessed on the Reading the Mind in the Eyes Test (RMET), measures of social functioning, and social well-being. The associations between RMET performance, social functioning, and cognitive status were analysed using generalised linear models, adjusting for demographic variables.

Results: Participants with MCI (b=-.52, 95% CI [-.70, -.33]) and dementia (b=-.78, 95% CI [-1.22, -.34]) showed poorer RMET performance than cognitively normal participants. Participants with MCI and dementia reported reduced social network size (b=-.21, 95% CI [-.40, -.02] and b=-.90, 95% CI [-1.38, -.42], respectively) and participants with dementia reported increased loneliness (b = .36, 95% CI [.06, .67]). In dementia, poorer RMET performance was associated with increased loneliness (b=-.07, 95% CI [-.14, -.00]) and a trend for negative interactions with partners (b=-.37, 95% CI [-.74, .00]), but no significant associations were found in MCI.

Conclusions: MCI and dementia were associated with poor self-reported social function. ToM deficits were related to poor social function in dementia but not MCI. Findings highlight the importance of interventions to address social cognitive deficits in persons with dementia and education of support networks to facilitate positive interactions and social well-being.
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http://dx.doi.org/10.1017/S1355617721000898DOI Listing
September 2021

The accuracy of self-reported physical activity questionnaires varies with sex and body mass index.

PLoS One 2021 11;16(8):e0256008. Epub 2021 Aug 11.

Centre for Research on Ageing, Health and Wellbeing, Australian National University, Bruce, ACT, Australia.

Background: Factors contributing to the accurate measurement of self-reported physical activity are not well understood in middle-aged adults. We investigated the associations between two self-reported surveys and objectively measured physical activity in middle-aged adults, and the influence of individual and sociodemographic factors on these associations, at different intensities utilizing an observational study design.

Methods: Participants (n = 156) wore a SenseWear Armband™ (SWA) for a continuous seven-day period over the triceps of the left arm, to measure energy expenditure in metabolic equivalents. Participants also completed the Physical Activity Recall questionnaire (PAR) and Active Australia Survey (AAS). Associations were analyzed separately in general linear models for each intensity. The influence of individual and sociodemographic factors was assessed through moderator analyses.

Results: The PAR and SWA were significantly positively associated at moderate (β = 0.68, 95% CI 0.16-1.20), vigorous (β = 0.36, 95% CI 0.20-0.53), moderate-to-vigorous physical activity (MVPA) (β = 0.52, 95% CI 0.20-0.83), and total METmins (β = 0.63, 95% CI 0.35-0.90), the AAS and SWA were associated at all intensities (moderate (β = 0.41, 95% CI 0.15-0.67), vigorous (β = 0.32, 95% CI 0.19-0.46), MVPA (β = 0.42, 95% CI 0.18-0.65) and total METmins (β = 0.62, 95% CI 0.29-0.96). A significant interaction between the PAR and sex for vigorous-intensity unveiled a weaker association in women. Both surveys tended to under-report physical activity. The largest margins of error were present at light and moderate intensities. For the PAR, participants reported over 20 hours, or 69% less light physical activity than recorded by the SWA per week. For the AAS, participants reported over 7 hours, or 38% less moderate physical activity. Compared to lighter intensities, time spent at a vigorous intensity was overreported by participants with the PAR and AAS by 91 and 43 minutes per week, respectively. The addition of Body Mass Index (BMI) resulted in non-significant interactions between the PAR and SWA for moderate-intensity, and the AAS and SWA for vigorous-intensity; a significant interaction between AAS and BMI indicated that the strength of the association differed by BMI for vigorous-intensity.

Conclusions: The PAR and AAS are not equivalent to the SWA, and sex and BMI may alter the associations between the measures.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0256008PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8357091PMC
August 2021

Association between decision-making under risk conditions and on-road driving safety among older drivers.

Neuropsychology 2021 Sep 22;35(6):622-629. Epub 2021 Jul 22.

UNSW Aging Futures Institute, University of New South Wales.

Despite theoretical models emphasizing the likely importance of adaptive decision-making to maintaining safety on the roads, there has been a lack of research investigating this topic. This exploratory study aimed to determine if decision-making under risk conditions, as measured by the Game of Dice Task (GDT), can explain additional variance in on-road driving safety beyond other well-validated predictors. Two hundred and thirty-nine cognitively normal Australian drivers aged 65-96 completed demographic and health questionnaires, vision testing, a neurocognitive test battery assessing cognitive flexibility, cognitive interference, episodic memory, verbal working memory, verbal fluency, and visuospatial function, the GDT-a lab-based assessment of decision-making under risk conditions, validated off-road driver screening measures and an on-road driving assessment along a standard route in urban traffic conditions administered by a trained Occupational Therapist (OT). The number of risky choices made, but not the number of strategy changes, across trials of the GDT independently predicted on-road safety ratings after controlling for visual acuity, cognitive test performance, and off-road driver screening measures, = -.146, 95% CI [-.276 to -.016]. Overall, this study offers the first evidence that decision-making is related to older adults' on-road driving safety, and makes recommendations for future research exploring the contribution of decision-making to on-road safety. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/neu0000754DOI Listing
September 2021

Nutrition Module design in Maintain Your Brain: an internet-based randomised controlled trial to prevent cognitive decline and dementia.

Br J Nutr 2021 Jun 3:1-10. Epub 2021 Jun 3.

Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.

The Maintain Your Brain (MYB) trial is one of the largest internet-delivered multidomain randomised controlled trial designed to target modifiable risk factors for dementia. It comprises four intervention modules: physical activity, nutrition, mental health and cognitive training. This paper explains the MYB Nutrition Module, which is a fully online intervention promoting the adoption of the 'traditional' Mediterranean Diet (MedDiet) pattern for those participants reporting dietary intake that does not indicate adherence to a Mediterranean-type cuisine or those who have chronic diseases/risk factors for dementia known to benefit from this type of diet. Participants who were eligible for the Nutrition Module were assigned to one of the three diet streams: Main, Malnutrition and Alcohol group, according to their medical history and adherence to the MedDiet at baseline. A short dietary questionnaire was administered weekly during the first 10 weeks and then monthly during the 3-year follow-up to monitor whether participants adopted or maintained the MedDiet pattern during the intervention. As the Nutrition Module is a fully online intervention, resources that promoted self-efficacy, self-management and process of change were important elements to be included in the module development. The Nutrition Module is unique in that it is able to individualise the dietary advice according to both the medical and dietary history of each participant; the results from this unique intervention will contribute substantively to the evidence that links the Mediterranean-type diet with cognitive function and the prevention of dementia and will increase our understanding of the benefits of a MedDiet in a Western country.
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http://dx.doi.org/10.1017/S0007114521001859DOI Listing
June 2021

Putting Fine Particulate Matter and Dementia in the Wider Context of Noncommunicable Disease: Where are We Now and What Should We Do Next: A Systematic Review.

Neuroepidemiology 2021 1;55(4):253-265. Epub 2021 Jun 1.

School of Psychology, University of New South Wales, Sydney, New South Wales, Australia.

Introduction: A significant proportion of the global population regularly experience air quality poorer than that recommended by the World Health Organization. Air pollution, especially fine particulate matter (PM2.5), is a risk factor for various noncommunicable diseases (NCDs) and is emerging as a risk factor for dementia. To begin to understand the full impact of PM2.5, we review the longitudinal epidemiological evidence linking PM2.5 to both dementia and to other leading NCDs and highlight the evidence gaps. Our objective was to systematically review the current epidemiological evidence for PM2.5 as a risk factor for cognitive decline and incident dementia and to put this in context with a systematic overview of PM2.5 as a potential risk factor in other leading NCDs.

Methods: We performed 2 systematic reviews. A high-level review of reviews examining the relationship between PM2.5 and leading NCDs and an in-depth review of the longitudinal epidemiological data examining relationships between PM2.5 incident dementia and cognitive decline.

Results: There were robust associations between PM2.5 and NCDs although in some cases the evidence was concentrated on short rather than longer term exposure. For those articles reporting on incident dementia, all reported on longer term exposure and 5 of the 7 eligible articles found PM2.5 to be associated with increased risk.

Conclusion: The evidence base for PM2.5 as a risk factor for dementia is growing. It is not yet as strong as that for other NCDs. However, varied measurement/methodology hampers clarity across the field. We propose next steps.
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http://dx.doi.org/10.1159/000515394DOI Listing
June 2021

Alzheimer's disease research progress in Australia: The Alzheimer's Association International Conference Satellite Symposium in Sydney.

Alzheimers Dement 2021 May 31. Epub 2021 May 31.

Departments of Neuroscience and Neurology, Center for Translational Research in Neurodegenerative Disease, Normal Fixel Center for Neurological Diseases, University of Florida College of Medicine, Gainesville, Florida, USA.

The Alzheimer's Association International Conference held its sixth Satellite Symposium in Sydney, Australia in 2019, highlighting the leadership of Australian researchers in advancing the understanding of and treatment developments for Alzheimer's disease (AD) and other dementias. This leadership includes the Australian Imaging, Biomarker, and Lifestyle Flagship Study of Ageing (AIBL), which has fueled the identification and development of many biomarkers and novel therapeutics. Two multimodal lifestyle intervention studies have been launched in Australia; and Australian researchers have played leadership roles in other global studies in diverse populations. Australian researchers have also played an instrumental role in efforts to understand mechanisms underlying vascular contributions to cognitive impairment and dementia; and through the Women's Healthy Aging Project have elucidated hormonal and other factors that contribute to the increased risk of AD in women. Alleviating the behavioral and psychological symptoms of dementia has also been a strong research and clinical focus in Australia.
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http://dx.doi.org/10.1002/alz.12380DOI Listing
May 2021

Impact of the COVID-19 pandemic and lockdown restrictions on psychosocial and behavioural outcomes among Australian adults with type 2 diabetes: Findings from the PREDICT cohort study.

Diabet Med 2021 09 18;38(9):e14611. Epub 2021 Jun 18.

Baker Heart and Diabetes Institute, Melbourne, Vic., Australia.

Aim: To examine psychosocial and behavioural impacts of the novel coronavirus disease 2019 (COVID-19) pandemic and lockdown restrictions among adults with type 2 diabetes.

Methods: Participants enrolled in the PRogrEssion of DIabetic ComplicaTions (PREDICT) cohort study in Melbourne, Australia (n = 489 with a baseline assessment pre-2020) were invited to complete a phone/online follow-up assessment in mid-2020 (i.e., amidst COVID-19 lockdown restrictions). Repeated assessments that were compared with pre-COVID-19 baseline levels included anxiety symptoms (7-item Generalised Anxiety Disorder scale [GAD-7]), depressive symptoms (8-item Patient Health Questionnaire [PHQ-8]), diabetes distress (Problem Areas in Diabetes scale [PAID]), physical activity/sedentary behaviour, alcohol consumption and diabetes self-management behaviours. Additional once-off measures at follow-up included COVID-19-specific worry, quality of life (QoL), and healthcare appointment changes (telehealth engagement and appointment cancellations/avoidance).

Results: Among 470 respondents (96%; aged 66 ± 9 years, 69% men), at least 'moderate' worry about COVID-19 infection was reported by 31%, and 29%-73% reported negative impacts on QoL dimensions (greatest for: leisure activities, feelings about the future, emotional well-being). Younger participants reported more negative impacts (p < 0.05). Overall, anxiety/depressive symptoms were similar at follow-up compared with pre-COVID-19, but diabetes distress reduced (p < 0.001). Worse trajectories of anxiety/depressive symptoms were observed among those who reported COVID-19-specific worry or negative QoL impacts (p < 0.05). Physical activity trended lower (~10%), but sitting time, alcohol consumption and glucose-monitoring frequency remained unchanged. 73% of participants used telehealth, but 43% cancelled a healthcare appointment and 39% avoided new appointments despite perceived need.

Conclusions: COVID-19 lockdown restrictions negatively impacted QoL, some behavioural risk factors and healthcare utilisation in adults with type 2 diabetes. However, generalised anxiety and depressive symptoms remained relatively stable.
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http://dx.doi.org/10.1111/dme.14611DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8237067PMC
September 2021

Trends in disability-free life expectancy at age 50 years in Australia between 2001 and 2011 by social disadvantage.

J Epidemiol Community Health 2021 Apr 28. Epub 2021 Apr 28.

School of Psychology, University of New South Wales, Sydney, New South Wales, Australia

Background: The aims of this study were (1) to estimate 10-year trends in disability-free life expectancy (DFLE) by area-level social disadvantage and (2) to examine how incidence, recovery and mortality transitions contributed to these trends.

Methods: Data were drawn from the nationally representative Household Income and Labour Dynamics in Australia survey. Two cohorts (baseline age 50+ years) were followed up for 7 years, from 2001 to 2007 and from 2011 to 2017, respectively. Social disadvantage was indicated by the Socio-Economic Indexes for Areas (SEIFA). Two DFLEs based on a Global Activity Limitation Indicator (GALI) and difficulties with activities of daily living (ADLs) measured by the 36-Item Short Form Survey physical function subscale were estimated by cohort, sex and SEIFA tertile using multistate models.

Results: Persons residing in the low-advantage tertile had more years lived with GALI and ADL disability than those in high-advantage tertiles. Across the two cohorts, dynamic equilibrium for GALI disability was observed among men in mid-advantage and high-advantage tertiles, but expansion of GALI disability occurred in the low-advantage tertile. There was expansion of GALI disability for all women irrespective of their SEIFA tertile. Compression of ADL disability was observed for all men and for women in the high-advantage tertile. Compared to the 2001 cohort, disability incidence was lower for the 2011 cohort of men within mid-advantage and high-advantage tertiles, whereas recovery and disability-related mortality were lower for the 2011 cohort of women within the mid-advantage tertile.

Conclusion: Overall, compression of morbidity was more common in high-advantage areas, whereas expansion of morbidity was characteristic of low-advantage areas. Trends also varied by sex and disability severity.
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http://dx.doi.org/10.1136/jech-2020-214906DOI Listing
April 2021

The role of cognition and reinforcement sensitivity in older adult decision-making under explicit risk conditions.

J Clin Exp Neuropsychol 2021 04 26;43(3):238-254. Epub 2021 Apr 26.

School of Psychology, University of New South Wales, Sydney, Australia.

: Previous research has suggested that individual differences in executive functions, memory and reinforcement sensitivity are associated with performance on behavioral decision-making tasks. Decision-making performance may also decline with age, however there is a lack of research on the interplay of cognitive and affective processes, and their impact on older adult decision-making. This study examined associations between executive functions, memory and reinforcement sensitivity on the Game of Dice Task (a measure of decision-making under explicit risk) among older adults.: One thousand and two older adults without cognitive impairment (aged 72-78 years) participated as part of an Australian longitudinal cohort study (the Personality and Total Health Through Life study). Decision-making sub-types were identified through cluster analysis and multinomial logistic regression was used to assess associations with measures of cognition and reinforcement sensitivity.: Cluster analysis identified three decision-making sub-types, which we label "advantageous," "disadvantageous" and "switching." Multivariate analyses found that relative to the mid-performing "switching" sub-type, advantageous decision-makers were more likely to be younger, male and have higher scores on a test of verbal learning. Disadvantageous decision-makers were more likely to have poorer scores on some components of executive function (set shifting, but not working memory or inhibitory control), although this effect was partly attenuated by a measure of reinforcement sensitivity (reward responsiveness).: These results indicate that specific components of learning and executive functions are influential in decision-making under explicit risk among a sample of older adults.
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http://dx.doi.org/10.1080/13803395.2021.1909709DOI Listing
April 2021

Cross-sectional association between objective cognitive performance and perceived age-related gains and losses in cognition.

Int Psychogeriatr 2021 Jul 14;33(7):727-741. Epub 2021 Apr 14.

Medical School, College of Medicine and Health, University of Exeter, Exeter, UK.

Objectives: Evidence linking subjective concerns about cognition with poorer objective cognitive performance is limited by reliance on unidimensional measures of self-perceptions of aging (SPA). We used the awareness of age-related change (AARC) construct to assess self-perception of both positive and negative age-related changes (AARC gains and losses). We tested whether AARC has greater utility in linking self-perceptions to objective cognition compared to well-established measures of self-perceptions of cognition and aging. We examined the associations of AARC with objective cognition, several psychological variables, and engagement in cognitive training.

Design: Cross-sectional observational study.

Participants: The sample comprised 6056 cognitively healthy participants (mean [SD] age = 66.0 [7.0] years); divided into subgroups representing middle, early old, and advanced old age.

Measurements: We used an online cognitive battery and measures of global AARC, AARC specific to the cognitive domain, subjective cognitive change, attitudes toward own aging (ATOA), subjective age (SA), depression, anxiety, self-rated health (SRH).

Results: Scores on the AARC measures showed stronger associations with objective cognition compared to other measures of self-perceptions of cognition and aging. Higher AARC gains were associated with poorer cognition in middle and early old age. Higher AARC losses and poorer cognition were associated across all subgroups. Higher AARC losses were associated with greater depression and anxiety, more negative SPA, poorer SRH, but not with engagement in cognitive training.

Conclusions: Assessing both positive and negative self-perceptions of cognition and aging is important when linking self-perceptions to cognitive functioning. Objective cognition is one of the many variables - alongside psychological variables - related to perceived cognitive losses.
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http://dx.doi.org/10.1017/S1041610221000375DOI Listing
July 2021

Association of sex differences in dementia risk factors with sex differences in memory decline in a population-based cohort spanning 20-76 years.

Sci Rep 2021 Apr 8;11(1):7710. Epub 2021 Apr 8.

Department of Psychology, University of Alberta, Edmonton, Canada.

Sex differences in late-life memory decline may be explained by sex differences in dementia risk factors. Episodic memory and dementia risk factors were assessed in young, middle-aged and older adults over 12 years in a population-based sample (N = 7485). For men in midlife and old age, physical, cognitive and social activities were associated with less memory decline, and financial hardship was associated with more. APOE e4 and vascular risk factors were associated with memory decline for women in midlife. Depression, cognitive and physical activity were associated with memory change in older women. Incident midlife hypertension (β = - 0.48, 95% CI - 0.87, - 0.09, p = 0.02) was associated with greater memory decline in women and incident late-life stroke accounted for greater memory decline in men (β = - 0.56, 95% CI - 1.12, - 0.01), p = 0.05). Women have fewer modifiable risk factors than men. Stroke and hypertension explained sex differences in memory decline for men and women respectively.
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http://dx.doi.org/10.1038/s41598-021-86397-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8032756PMC
April 2021

The effect of opioids on the cognitive function of older adults: results from the Personality and Total Health through life study.

Age Ageing 2021 Sep;50(5):1699-1708

Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australia.

Background: chronic pain, a common complaint among older adults, affects physical and mental well-being. While opioid use for pain management has increased over the years, pain management in older adults remains challenging, due to potential severe adverse effects of opioids in this population.

Objective: we examined the association between opioid use, and changes in cognitive function of older adults.

Design: prospective study.

Setting: community dwelling older adults.

Subjects: study population consisted of 2,222 individuals aged 65-69 years at baseline from the Personality and Total Health Through Life Study in Australia.

Methods: medication data were obtained from the Pharmaceutical Benefits Scheme. Cognitive measures were obtained from neuropsychological battery assessment. Opioid exposure was quantified as Total Morphine Equivalent Dose (MED). The association between change in cognitive function between Wave 2 and Wave 3, and cumulative opioid use was assessed through generalized linear models.

Results: cumulative opioid exposure exceeding total MED of 2,940 was significantly associated with poorer performance in the Mini Mental State Examination (MMSE). Compared with those not on opioids, individuals exposed to opioids resulting in cumulative total MED of greater than 2,940 had significantly lower scores in the MMSE (Model 1: β = -0.34, Model 2: β = -0.35 and Model 3: β = -0.39, P < 0.01). Performance in other cognitive assessments was not associated with opioid use.

Conclusion: prolonged opioid use in older adults can affect cognitive function, further encouraging the need for alternative pain management strategies in this population. Pain management options should not adversely affect healthy ageing trajectories and cognitive health.
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http://dx.doi.org/10.1093/ageing/afab048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8437064PMC
September 2021

Systematic review of coexistent epileptic seizures and Alzheimer's disease: Incidence and prevalence.

J Am Geriatr Soc 2021 Jul 19;69(7):2011-2020. Epub 2021 Mar 19.

Neuroscience Research Australia, Sydney, New South Wales, Australia.

Background/objectives: Coexistent seizures add complexity to the burden of Alzheimer's disease (AD). We aim to estimate the incidence and prevalence of coexistent seizures and AD and summarize characteristics.

Design: A systematic review and meta-analysis (PROSPERO protocol registration CRD42020150479).

Setting: Population-, community-, hospital-, or nursing home-based.

Participants And Measurements: Thirty-nine studies reporting on seizure incidence and prevalence in 21,198 and 380,777 participants with AD, respectively, and AD prevalence in 727,446 participants with seizures. When statistical heterogeneity and inconsistency (assessed by Q statistic and I ) were not shown, rates were synthesized using random effect.

Results: Studies were conducted in Australia, Brazil, Finland, France, Ireland, Italy, Japan, Netherlands, Portugal, Sweden, Taiwan, United Kingdom, and United States. The incidence of seizures among people with clinically diagnosed AD ranged from 4.2 to 31.5 per 1000 person-years. Prevalence of seizures among people with clinically diagnosed AD ranged from 1.5% to 12.7% generally, but it rose to the highest (49.5% of those with early-onset AD) in one study. Meta-analysis reported a combined seizure prevalence rate among people with pathologically verified AD at 16% (95% confidence interval [CI] 14-19). Prevalence of seizure in autosomal dominant AD (ADAD) ranged from 2.8% to 41.7%. Being younger was associated with higher risk of seizure occurrence. Eleven percent of people with adult-onset seizures had AD (95%CI, 7-14).

Conclusion: Seizures are common in those with AD, and seizure monitoring may be particularly important for younger adults and those with ADAD.
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http://dx.doi.org/10.1111/jgs.17101DOI Listing
July 2021

Trends in anticholinergic and opioid dispensing in older adults from 2004 to 2015: Results from the Personality and Total Health (PATH) Through Life Study.

Australas J Ageing 2021 Jun 14;40(2):e173-e177. Epub 2021 Feb 14.

Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, ACT, Australia.

Objective: Due to potential adverse effects, guidelines recommend that anticholinergics and opioids be avoided in older adults unless necessary. This study examines the dispensing trends of these medications among older Australians.

Methods: Data of 2222 PATH study (60+ cohort) participants were analysed. Medication dispensing data were obtained from the Pharmaceutical Benefits Scheme from April 2004 to March 2015. Temporal trends of prescriptions dispensed were assessed using joinpoint regression analysis.

Results: Of all dispensed prescriptions, 5.5% were for anticholinergics and opioids, and 46.2% of anticholinergics dispensed were anti-depressants. Anticholinergic dispensing trend increased in 2004-2015 (annual per cent change, APC = 3.4%), particularly for moderately anticholinergic medications (APC = 6.8%). Dispensing trend for opioids increased in 2004-2011 (APC = 11.3%) and declined in 2011-2015 (APC = -4.4%).

Conclusion: While guidelines urge caution in prescribing these medications to older adults, dispensing increased over time in this study population.
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http://dx.doi.org/10.1111/ajag.12915DOI Listing
June 2021

Intergenerational Programmes bringing together community dwelling non-familial older adults and children: A Systematic Review.

Arch Gerontol Geriatr 2021 May-Jun;94:104356. Epub 2021 Jan 28.

Department of Medicine, Dalhousie University, Canada.

Background: Social isolation is associated with an increased risk of adverse health outcomes, including functional decline, cognitive decline, and dementia. Intergenerational engagement, i.e. structured or semi structured interactions between non-familial older adults and younger generations is emerging as a tool to reduce social isolation in older adults and to benefit children and adults alike. This has great potential for our communities, however, the strength and breadth of the evidence for this is unclear. We undertook a systematic review to summarise the existing evidence for intergenerational interventions with community dwelling non-familial older adults and children, to identify the gaps and to make recommendations for the next steps.

Methods: Medline, Embase and PsychInfo were searched from inception to the 28 Sept 2020. Articles were included if they reported research studies evaluating the use of non-familial intergenerational interaction in community dwelling older adults. PROSPERO registration number CRD42020175927 RESULTS: Twenty articles reporting on 16 studies were included. Although all studies reported positive effects in general, numerical outcomes were not recorded in some cases, and outcomes and assessment tools varied and were administered un-blinded. Caution is needed when making interpretations about the efficacy of intergenerational programmes for improving social, health and cognitive outcomes.

Discussion: Overall, there is neither strong evidence for nor against community based intergenerational interventions. The increase in popularity of intergenerational programmes alongside the strong perception of potential benefit underscores the urgent need for evidence-based research.
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http://dx.doi.org/10.1016/j.archger.2021.104356DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8439135PMC
May 2021

Dementia risk reduction in practice: the knowledge, opinions and perspectives of Australian healthcare providers.

Aust J Prim Health 2021 Feb 11. Epub 2021 Feb 11.

This study examined Australian primary healthcare providers' knowledge about dementia risk factors and risk reduction and their perspectives on barriers and enablers to risk reduction in practice. Primary healthcare providers were recruited through Primary Health Networks across Australia (n=51). Participants completed an online survey that consisted of fixed-responses and free-text components to assess their knowledge, attitudes and current practices relating to dementia risk factors and risk reduction techniques. The results showed that Australian primary healthcare providers have good knowledge about the modifiable risk factors for dementia; however, face several barriers to working with patients to reduce dementia risk. Commonly reported barriers included low patient motivation and healthcare system level limitations. The most commonly reported recommendations to helping primary healthcare providers to work with patients to reduce dementia risk included increasing resources and improving dementia awareness and messaging. While the results need to be interpreted in the context of the limitations of this study, we conclude that collaborative efforts between researchers, clinicians, policy makers and the media are needed to support the uptake of risk reduction activities in primary care settings.
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http://dx.doi.org/10.1071/PY20189DOI Listing
February 2021

Hazard Perception in Older Drivers With Eye Disease.

Transl Vis Sci Technol 2021 01 22;10(1):31. Epub 2021 Jan 22.

School of Psychology, The University of Queensland, Brisbane, Australia.

Purpose: Timely detection of hazards is a key driving skill; however, the hazard perception of drivers with eye disease and related visual changes and the visual predictors of hazard perception are poorly understood.

Methods: Participants included drivers aged 65 years and older with a range of eye diseases, including cataract, age-related maculopathy (AMD), and glaucoma ( = 99; mean age, 75.4 ± 6.4 years) and controls ( = 118; mean age, 72.2 ± 5.5 years). Visual performance was assessed using clinical measures (visual acuity, contrast sensitivity, visual fields) and non-clinical measures (useful field of view, motion sensitivity). Participants completed a computer-based hazard perception test (HPT) that has been related to driving performance and crash risk.

Results: Participants with eye disease exhibited a 0.73-second delay in HPT response times compared to controls (6.61 ± 1.62 seconds vs. 5.88 ± 1.38 seconds; age-adjusted = 0.012). Participants with glaucoma exhibited significantly delayed responses compared to those with AMD ( = 0.038) and controls ( = 0.004). Poorer motion sensitivity (standardized β = 0.27; < 0.001), visual acuity (β = 0.21; = 0.002), and better-eye mean defect (β = -0.17; = 0.009) were most strongly associated with delayed HPT responses. Motion sensitivity remained significantly associated with HPT responses, adjusted for visual acuity and visual fields.

Conclusions: HPT responses of older drivers with eye disease were delayed compared to controls and translate to an estimated 16-meter longer stopping distance when traveling at 80 km/hr. Decreased motion sensitivity was most strongly associated with delayed HPT responses.

Translational Relevance: HPT tests can provide insight into difficulties regarding road hazard detection of older drivers with eye disease and provide a potential avenue for interventions to improve road safety.
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http://dx.doi.org/10.1167/tvst.10.1.31DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7838553PMC
January 2021

Dementia stigma reduction (DESeRvE) through education and virtual contact in the general public: A multi-arm factorial randomised controlled trial.

Dementia (London) 2021 Aug 31;20(6):2152-2169. Epub 2021 Jan 31.

6803Neuroscience Research Australia, Sydney, Australia; School of Psychology, 7800University of New South Wales, Sydney, Australia.

Objective: To examine the efficacy of the Dementia Stigma Reduction (DESeRvE) programme, aimed at reducing the general public dementia-related stigma utilising 'education' and 'contact' approaches.

Methods: A total of 1024 Australians aged between 40 and 87 years (M = 60.8, = 10.1) participated in a factorial randomised controlled trial. This trial examined four conditions: online education programme (ED), contact through simulated contact with people with dementia and carers (CT), education and contact (ED+CT) and active control. Cognitive, emotional and behavioural aspects of dementia-related stigma were measured with a modified Attribution Questionnaire, and dementia knowledge was measured with the Dementia Knowledge Assessment Scale at the baseline, immediately and 12 weeks after the completion of the intervention.

Results: All four groups improved (reduction in scores) significantly from baseline to week 12 in dementia-related stigma, and the effects were stronger for those with higher baseline stigma scores. Intervention groups also improved significantly from baseline in dementia knowledge. Especially, the ED (β = .85, SE = .07; < .001) and ED+CT (β = .78, SE = .08; < .001) groups at immediate follow-up and CT (β = .21, SE = .09; < .05) and ED+CT (β = .32, SE = .09; < .001) at 12-week follow-up showed significant effects.

Conclusions: Findings suggest that DESeRvE can be a valuable tool to enhance public's dementia knowledge and reduce dementia-related stigma, especially for those with higher levels of stigma. Reduction in stigma, however, may take a longer time to achieve, whereas improvement in dementia knowledge is instant.
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http://dx.doi.org/10.1177/1471301220987374DOI Listing
August 2021

Estimating prevalence of subjective cognitive decline in and across international cohort studies of aging: a COSMIC study.

Alzheimers Res Ther 2020 12 18;12(1):167. Epub 2020 Dec 18.

Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

Background: Subjective cognitive decline (SCD) is recognized as a risk stage for Alzheimer's disease (AD) and other dementias, but its prevalence is not well known. We aimed to use uniform criteria to better estimate SCD prevalence across international cohorts.

Methods: We combined individual participant data for 16 cohorts from 15 countries (members of the COSMIC consortium) and used qualitative and quantitative (Item Response Theory/IRT) harmonization techniques to estimate SCD prevalence.

Results: The sample comprised 39,387 cognitively unimpaired individuals above age 60. The prevalence of SCD across studies was around one quarter with both qualitative harmonization/QH (23.8%, 95%CI = 23.3-24.4%) and IRT (25.6%, 95%CI = 25.1-26.1%); however, prevalence estimates varied largely between studies (QH 6.1%, 95%CI = 5.1-7.0%, to 52.7%, 95%CI = 47.4-58.0%; IRT: 7.8%, 95%CI = 6.8-8.9%, to 52.7%, 95%CI = 47.4-58.0%). Across studies, SCD prevalence was higher in men than women, in lower levels of education, in Asian and Black African people compared to White people, in lower- and middle-income countries compared to high-income countries, and in studies conducted in later decades.

Conclusions: SCD is frequent in old age. Having a quarter of older individuals with SCD warrants further investigation of its significance, as a risk stage for AD and other dementias, and of ways to help individuals with SCD who seek medical advice. Moreover, a standardized instrument to measure SCD is needed to overcome the measurement variability currently dominant in the field.
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http://dx.doi.org/10.1186/s13195-020-00734-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7749505PMC
December 2020

What does (low) education mean in terms of dementia risk? A systematic review and meta-analysis highlighting inconsistency in measuring and operationalising education.

SSM Popul Health 2020 Dec 29;12:100654. Epub 2020 Aug 29.

School of Psychology, University of New South Wales, Sydney, New South Wales, Australia.

Low education is considered an important modifiable risk factor for dementia worldwide, despite the lack of a formal consensus definition of low education. The primary aim of this systematic review was to document and address the inconsistency in measuring and operationalising education in dementia studies. A secondary aim was to consider the dose of education required to reduce dementia risk. The protocol was registered at PROSPERO with registration ID CRD42018096168. CINAHL, Cochrane, PsycInfo, and Pubmed databases were searched using terms related to education, dementia and/or MCI, and incidence. Studies were eligible for inclusion if a risk ratio for education and any dementia, Alzheimer's Disease (AD), Vascular Dementia (VaD) or Mild Cognitive Impairment (MCI) was reported in a population cognitively healthy at baseline. Sample sizes for 65 studies meeting selection criteria ranged from 152 to 12,881, representing populations from 24 countries. Risk of bias, assessed using a tool designed specifically for dementia risk studies, was found to be medium or low for all studies. There were 23 continuous, 29 dichotomous, and 31 categorical operationalisations of education reported. Random effects meta-analyses from continuous operationalisations suggested each year of education reduced risk by eight percent for AD (95% CI:5-12%) and seven percent for any dementia (95% CI:6-9%). Dichotomous operationalisations indicated an increased risk for low education of 45% (95% CI:29-63%) for any dementia and 85% (95% CI:56-118%) for AD, however definitions of low education were heterogeneous, ranging from zero to 12 years. There were too few studies to produce summary ratios for VaD or MCI. We conclude that, while the evidence of an association between low education and dementia incidence is robust, inconsistency in the definition, measurement and operationalisation of education hinders the translation of this evidence into practical policy recommendations to reduce dementia risk.
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http://dx.doi.org/10.1016/j.ssmph.2020.100654DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7721642PMC
December 2020

Testing Age Differences in the links between Recent Financial Difficulties and Cognitive Deficits: Longitudinal Evidence from the PATH Through Life Study.

J Gerontol B Psychol Sci Soc Sci 2020 Dec 1. Epub 2020 Dec 1.

Centre for Research on Ageing Health and Wellbeing, Research School of Population Health, The Australian National University, Australia.

Objective: This study investigates whether the within-person associations between a recent major financial crisis and deficits in cognitive performance vary across the lifecourse.

Method: Four waves of data from 7442 participants (49% men) spanning 12-years and comprising three narrow age birth cohorts (baseline age: 20-25, 40-45, and 60-65) were drawn from a representative prospective survey from Canberra, Australia (1999-2014). Cognitive performance was assessed by the California Verbal Leaning Test (CVLT) immediate recall trails, Symbol Digit Modalities Test (SDMT), Backwards Digitspan (BDS), and Trail Making Test B (TMT B). A single item from the Threatening Life Experiences Questionnaire assessed self-reported major financial crisis in the past 6-months. Multi-variable adjusted fixed effect regression models tested the time-dependent association between financial crisis and cognition.

Results: A recent financial crisis coincided with contemporaneous declines in CVLT (Mean change = -0.14, 95% CI = -0.262, -0.025), SDMT (Mean change = -0.08, 95% CI = -0.147,-0.004) and TMT-B (Mean change = -0.17, 95% CI = -0.293,-0.039) for adults in the oldest age group, and these associations were larger than in the younger age groups. In contrast, there was an overall association between financial crisis and deficits in BDS (Mean change = -0.06, 95% CI = -0.105, -0.007), with weak evidence of stronger associations in mid-life relative to other age groups. These associations were independent of changes in health and socio-economic circumstances.

Discussion: This study provides important new evidence that financial difficulties in later life are potent stressors associated with occasion specific deficits in cognitive performance.
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http://dx.doi.org/10.1093/geronb/gbaa215DOI Listing
December 2020

The Impact of Smoking and Obesity on Disability-Free Life Expectancy in Older Australians.

J Gerontol A Biol Sci Med Sci 2021 Jun;76(7):1265-1272

Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.

Background: Smoking and obesity are 2 modifiable risk factors for disability. We examine the impact of smoking and obesity on disability-free life expectancy (DFLE) at older ages, using 2 levels of disability.

Method: We used the DYNOPTA dataset, derived by harmonizing and pooling risk factors and disability outcomes from 5 Australian longitudinal aging studies. We defined mobility disability as inability to walk 1 km, and more severe (activities of daily living [ADL]) disability by the inability to dress or bathe. Mortality data for the analytic sample (N = 20 401; 81.2% women) were obtained from Government Records via data linkage. We estimated sex-specific total life expectancy, DFLE, and years spent with disability by Interpolated Markov Chain (IMaCh) software for each combination of smoking (never vs ever), obesity (body mass index ≥30 vs 18.5 to <30), and education (left school age 14 or younger vs age 15 or older).

Results: Compared to those without either risk factor, high educated nonobese smokers at age 65 lived shorter lives (men and women: 2.5 years) and fewer years free of mobility disability (men: 2.1 years; women: 2.0 years), with similar results for ADL disability. Obesity had the largest effect on mobility disability in women; high educated obese nonsmoking women lived 1.3 years less than nonsmoking, not obese women but had 5.1 years fewer free of mobility disability and 3.2 fewer free of ADL disability. Differences between risk factor groups were similar for the low educated.

Conclusions: Our findings suggest eliminating obesity would lead to an absolute reduction of disability, particularly in women.
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http://dx.doi.org/10.1093/gerona/glaa290DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8202145PMC
June 2021

Cohort Profile Update: The PATH Through Life Project.

Int J Epidemiol 2021 03;50(1):35-36

Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, Australian National University, Canberra, ACT, Australia.

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http://dx.doi.org/10.1093/ije/dyaa179DOI Listing
March 2021

Longitudinal trajectories of hippocampal volume in middle to older age community dwelling individuals.

Neurobiol Aging 2021 01 21;97:97-105. Epub 2020 Oct 21.

Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.

Understanding heterogeneity in brain aging trajectories is important to estimate the extent to which aging outcomes can be optimized. Although brain changes in late life are well-characterized, brain changes in middle age are not well understood. In this study, we investigated hippocampal change in a generally healthy community-living population of middle (n = 421, mean age 47.2 years) and older age (n = 411, mean age 63.0 years) individuals, over a follow-up of up to 12 years. Manually traced hippocampal volumes were analyzed using multilevel models and latent class analysis to investigate longitudinal aging trajectories and laterality and sex effects, and to identify subgroups that follow different aging trajectories. Hippocampal volumes decreased on average by 0.18%/year in middle age and 0.3%/year in older age. Men tended to experience steeper declines than women in middle age only. Three subgroups of individuals following different trajectories were identified in middle age and 2 in older age. Contrary to expectations, the subgroup containing two-thirds of older age participants maintained stable hippocampal volumes across the follow-up.
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http://dx.doi.org/10.1016/j.neurobiolaging.2020.10.011DOI Listing
January 2021

Yoga-based exercise to prevent falls in community-dwelling people aged 60 years and over: study protocol for the Successful AGEing (SAGE) yoga randomised controlled trial.

BMJ Open Sport Exerc Med 2020 29;6(1):e000878. Epub 2020 Sep 29.

Institute for Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.

Introduction: Falls significantly reduce independence and quality of life in older age. Balance-specific exercise prevents falls in people aged 60+ years. Yoga is growing in popularity and can provide a high challenge to balance; however, the effect of yoga on falls has not been evaluated. This trial aims to establish the effect on falls of a yoga exercise programme compared with a yoga relaxation programme in community-dwellers aged 60+ years.

Method And Analysis: This randomised controlled trial will involve 560 community-dwelling people aged 60+ years. Participants will be randomised to either: (1) the Successful AGEing () yoga exercise programme or (2) a yoga relaxation programme. Primary outcome is rate of falls in the 12 months post randomisation. Secondary outcomes include mental well-being, physical activity, health-related quality of life, balance self-confidence, physical function, pain, goal attainment and sleep quality at 12 months after randomisation. The number of falls per person-year will be analysed using negative binomial regression models to estimate between-group difference in fall rates. Generalised linear models will assess the effect of group allocation on the continuously scored secondary outcomes, adjusting for baseline scores. An economic analysis will compare the cost-effectiveness and cost-utility of the two yoga programmes.

Ethics And Dissemination: Protocol was approved by the Human Research Ethics Committee at The University of Sydney, Australia (approval 2019/604). Trial results will be disseminated via peer-reviewed articles, conference presentations, lay summaries.

Trial Registration Number: The protocol for this trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619001183178).
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http://dx.doi.org/10.1136/bmjsem-2020-000878DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7534729PMC
September 2020

An Internet-Based Intervention Augmented With a Diet and Physical Activity Consultation to Decrease the Risk of Dementia in At-Risk Adults in a Primary Care Setting: Pragmatic Randomized Controlled Trial.

J Med Internet Res 2020 09 24;22(9):e19431. Epub 2020 Sep 24.

Department of General Practice, University of Newcastle, Newcastle, Australia.

Background: There is a need to develop interventions to reduce the risk of dementia in the community by addressing lifestyle factors and chronic diseases over the adult life course.

Objective: This study aims to evaluate a multidomain dementia risk reduction intervention, Body Brain Life in General Practice (BBL-GP), targeting at-risk adults in primary care.

Methods: A pragmatic, parallel, three-arm randomized trial involving 125 adults aged 18 years or older (86/125, 68.8% female) with a BMI of ≥25 kg/m or a chronic health condition recruited from general practices was conducted. The arms included (1) BBL-GP, a web-based intervention augmented with an in-person diet and physical activity consultation; (2) a single clinician-led group, Lifestyle Modification Program (LMP); and (3) a web-based control. The primary outcome was the Australian National University Alzheimer Disease Risk Index Short Form (ANU-ADRI-SF).

Results: Baseline assessments were conducted on 128 participants. A total of 125 participants were randomized to 3 groups (BBL-GP=42, LMP=41, and control=42). At immediate, week 18, week 36, and week 62 follow-ups, the completion rates were 43% (18/42), 57% (24/42), 48% (20/42), and 48% (20/42), respectively, for the BBL-GP group; 71% (29/41), 68% (28/41), 68% (28/41), and 51% (21/41), respectively, for the LMP group; and 62% (26/42), 69% (29/42), 60% (25/42), and 60% (25/42), respectively, for the control group. The primary outcome of the ANU-ADRI-SF score was lower for the BBL-GP group than the control group at all follow-ups. These comparisons were all significant at the 5% level for estimates adjusted for baseline differences (immediate: difference in means -3.86, 95% CI -6.81 to -0.90, P=.01; week 18: difference in means -4.05, 95% CI -6.81 to -1.28, P<.001; week 36: difference in means -4.99, 95% CI -8.04 to -1.94, P<.001; and week 62: difference in means -4.62, 95% CI -7.62 to -1.62, P<.001).

Conclusions: A web-based multidomain dementia risk reduction program augmented with allied health consultations administered within the general practice context can reduce dementia risk exposure for at least 15 months. This study was limited by a small sample size, and replication on a larger sample with longer follow-up will strengthen the results.

Trial Registration: Australian clinical trials registration number (ACTRN): 12616000868482; https://anzctr.org.au/ACTRN12616000868482.aspx.
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http://dx.doi.org/10.2196/19431DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7545332PMC
September 2020

Future Directions for Dementia Risk Reduction and Prevention Research: An International Research Network on Dementia Prevention Consensus.

J Alzheimers Dis 2020 ;78(1):3-12

Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA.

In the past decade a large body of evidence has accumulated on risk factors for dementia, primarily from Europe and North America. Drawing on recent integrative reviews and a consensus workshop, the International Research Network on Dementia Prevention developed a consensus statement on priorities for future research. Significant gaps in geographical location, representativeness, diversity, duration, mechanisms, and research on combinations of risk factors were identified. Future research to inform dementia risk reduction should fill gaps in the evidence base, take a life-course, multi-domain approach, and inform population health approaches that improve the brain-health of whole communities.
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http://dx.doi.org/10.3233/JAD-200674DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7609069PMC
January 2020

Lifestyle Risk Factors and Cognitive Outcomes from the Multidomain Dementia Risk Reduction Randomized Controlled Trial, Body Brain Life for Cognitive Decline (BBL-CD).

J Am Geriatr Soc 2020 11 9;68(11):2629-2637. Epub 2020 Sep 9.

Neuroscience Research Australia (NeuRA), Sydney, Australia.

Background/objectives: To evaluate the efficacy of a multidomain intervention to reduce lifestyle risk factors for Alzheimer's disease (AD) and improve cognition in individuals with subjective cognitive decline (SCD) or mild cognitive impairment (MCI).

Design: The study was an 8-week two-arm single-blind proof-of-concept randomized controlled trial.

Setting: Community-dwelling individuals living in Canberra, Australia, and surrounding areas.

Participants: Participants were 119 individuals (intervention n = 57; control n = 62) experiencing SCD or MCI.

Intervention: The control condition involved four educational modules covering dementia and lifestyle risk factors, Mediterranean diet, physical activity, and cognitive engagement. Participants were instructed to implement this information into their own lifestyle. The intervention condition included the same educational modules and additional active components to assist with the implementation of this information into participants' lifestyles: dietitian sessions, an exercise physiologist session, and online brain training.

Measurements: Lifestyle risk factors for AD were assessed using the Australian National University-Alzheimer's Disease Risk Index (ANU-ADRI), and cognition was assessed using Alzheimer's Disease Assessment Scale-Cognitive subscale, Pfeffer Functional Activities Questionnaire, Symbol Digit Modalities Test (SDMT), Trail Making Test-B, and Category Fluency.

Results: The primary analysis showed that the intervention group had a significantly lower ANU-ADRI score (χ = 10.84; df = 3; P = .013) and a significantly higher cognition score (χ = 7.28; df = 2; P = .026) than the control group. A secondary analysis demonstrated that the changes in lifestyle were driven by increases in protective lifestyle factors (χ = 12.02; df = 3; P = .007), rather than a reduction in risk factors (χ = 2.93; df = 3; P = .403), and cognitive changes were only apparent for the SDMT (χ = 6.46; df = 2; P = .040). Results were robust to intention-to-treat analysis controlling for missing data.

Conclusion: Results support the hypothesis that improvements in lifestyle risk factors for dementia can lead to improvements in cognition over a short time frame with a population experiencing cognitive decline. Outcomes from this trial support the conduct of a larger and longer trial with this participant group.
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http://dx.doi.org/10.1111/jgs.16762DOI Listing
November 2020

Cognitive health expectancies of cardiovascular risk factors for cognitive decline and dementia.

Age Ageing 2021 01;50(1):169-175

Neuroscience Research Australia, Sydney, Australia.

Background: Cognitive health expectancy estimates the proportion of the lifespan that is lived in good cognitive health at the population level. A number of cardiovascular diseases have been identified to be risk factors for cognitive decline and dementia including diabetes, stroke, heart diseases and hypertension. The aim of this study was to examine how these cardiovascular conditions relate to cognitive health expectancy.

Methods: Longitudinal data were obtained from the US Health and Retirement Study. Multistate modelling was used to estimate total life expectancy (LE), cognitive impairment free life expectancy (CIFLE) and years spent with cognitive impairment (CILE) across self-reported diabetes, hypertension, heart problems and stroke. Individual and cumulative effects of multiple cardiovascular conditions were examined.

Results: The presence of cardiovascular disease was associated with a 5- to 9-year decrease in LE and 4- to 8-year decrease in CIFLE at age 55. The outcomes varied in a hierarchical fashion by cardiovascular condition. Relative to other conditions, individuals with stroke had the shortest LE and CIFLE. Analysis of multiple cardiovascular risk factors revealed that each additional cardiovascular condition was associated with an exponential decrease in LE and CIFLE.

Conclusions: Having a cardiovascular condition is associated with a lower CIFLE and higher proportion of life lived with cognitive impairment. However, the outcomes vary depending on the type of cardiovascular condition. Reducing incidence of stroke and minimising exposure to multiple cardiovascular risk factors may be beneficial in helping to improve population estimates of cognitive health expectancy.
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http://dx.doi.org/10.1093/ageing/afaa111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7793598PMC
January 2021

Education and the moderating roles of age, sex, ethnicity and apolipoprotein epsilon 4 on the risk of cognitive impairment.

Arch Gerontol Geriatr 2020 Nov/Dec;91:104112. Epub 2020 Jul 13.

Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea.

Background: We examined how the relationship between education and latelife cognitive impairment (defined as a Mini Mental State Examination score below 24) is influenced by age, sex, ethnicity, and Apolipoprotein E epsilon 4 (APOE*4).

Methods: Participants were 30,785 dementia-free individuals aged 55-103 years, from 18 longitudinal cohort studies, with an average follow-up ranging between 2 and 10 years. Pooled hazard ratios were obtained from multilevel parametric survival analyses predicting cognitive impairment (CI) from education and its interactions with baseline age, sex, APOE*4 and ethnicity. In separate models, education was treated as continuous (years) and categorical, with participants assigned to one of four education completion levels: Incomplete Elementary; Elementary; Middle; and High School.

Results: Compared to Elementary, Middle (HR = 0.645, P = 0.004) and High School (HR = 0.472, P < 0.001) education were related to reduced CI risk. The decreased risk of CI associated with Middle education weakened with older baseline age (HR = 1.029, P = 0.056) and was stronger in women than men (HR = 1.309, P = 0.001). The association between High School and lowered CI risk, however, was not moderated by sex or baseline age, but was stronger in Asians than Whites (HR = 1.047, P = 0.044), and significant among Asian (HR = 0.34, P < 0.001) and Black (HR = 0.382, P = 0.016), but not White, APOE*4 carriers.

Conclusion: High School completion may reduce risk of CI associated with advancing age and APOE*4. The observed ethnoregional differences in this effect are potentially due to variations in social, economic, and political outcomes associated with educational attainment, in combination with neurobiological and genetic differences, and warrant further study.
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http://dx.doi.org/10.1016/j.archger.2020.104112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7724926PMC
December 2020
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