المؤلفون: Quaye, Emmanuel, Galecki, Andrzej T, Tilton, Nicholas, Whitney, Rachael, Briceño, Emily M, Elkind, Mitchell SV, Fitzpatrick, Annette L, Gottesman, Rebecca F, Griswold, Michael, Gross, Alden L, Heckbert, Susan R, Hughes, Timothy M, Longstreth, WT, Sacco, Ralph L, Sidney, Stephen, Windham, B Gwen, Yaffe, Kristine, Levine, Deborah A

المصدر: Neurology. 100(2)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Nutrition and Dietetics, Clinical Research, Nutrition, Clinical Trials and Supportive Activities, Aging, Brain Disorders, Acquired Cognitive Impairment, Obesity, Stroke, Female, Humans, Male, Middle Aged, Cognition, Cognitive Dysfunction, Risk Factors, White, Black or African American, Aged, United States, Clinical Sciences, Neurosciences, Cognitive Sciences, Neurology & Neurosurgery, Clinical sciences

الوصف: Background and objectivesThere are disparities in the prevalence of obesity by race, and the relationship between obesity and cognitive decline is unclear. The objective of this study was to determine whether obesity is independently associated with cognitive decline and whether the association between obesity and cognitive decline differs in Black and White adults. We hypothesized that obesity is associated with greater cognitive decline compared with normal weight and that the effect of obesity on cognitive decline is more pronounced in Black adults compared with their White counterparts.MethodsWe pooled data from 28,867 participants free of stroke and dementia (mean, SD: age 61 [10.7] years at the first cognitive assessment, 55% female, 24% Black, and 29% obese) from 6 cohorts. The primary outcome was the annual change in global cognition. We performed linear mixed-effects models with and without time-varying cumulative mean systolic blood pressure (SBP) and fasting plasma glucose (FPG). Global cognition was set to a t-score metric (mean 50, SD 10) at a participant's first cognitive assessment; a 1-point difference represents a 0.1 SD difference in global cognition across the 6 cohorts. The median follow-up was 6.5 years (25th percentile, 75th percentile: 5.03, 20.15).ResultsObese participants had lower baseline global cognition than normal-weight participants (difference in intercepts, -0.36 [95% CI, -0.46 to -0.17]; p < 0.001). This difference in baseline global cognition was attenuated but was borderline significant after accounting for SBP and FPG (adjusted differences in intercepts, -0.19 [95% CI, -0.39 to 0.002]; p = 0.05). There was no difference in the rate of decline in global cognition between obese and normal-weight participants (difference in slope, 0.009 points/year [95% CI, -0.009 to 0.03]; p = 0.32). After accounting for SBP and FPG, obese participants had a slower decline in global cognition (adjusted difference in slope, 0.03 points/year slower [95% CI, 0.01 to 0.05]; p < 0.001). There was no evidence that race modified the association between body mass index and global cognitive decline (p = 0.34).DiscussionThese results suggest that obesity is associated with lower initial cognitive scores and may potentially attenuate declines in cognition after accounting for BP and FPG.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/5sz7f564Test

المؤلفون: Levine, Deborah A, Gross, Alden L, Briceño, Emily M, Tilton, Nicholas, Whitney, Rachael, Han, Dehua, Giordani, Bruno J, Sussman, Jeremy B, Hayward, Rodney A, Burke, James F, Elkind, Mitchell SV, Moran, Andrew E, Tom, Sarah, Gottesman, Rebecca F, Gaskin, Darrell J, Sidney, Stephen, Yaffe, Kristine, Sacco, Ralph L, Heckbert, Susan R, Hughes, Timothy M, Lopez, Oscar L, Allen, Norrina Bai, Galecki, Andrzej T

المصدر: Journal of Alzheimer's Disease. 89(3)

مصطلحات موضوعية: Biological Psychology, Psychology, Aging, Brain Disorders, Acquired Cognitive Impairment, Dementia, Behavioral and Social Science, Neurosciences, Clinical Research, Cardiovascular, Aged, Blood Pressure, Cognition, Cohort Studies, Female, Hispanic or Latino, Humans, Male, Risk Factors, White People, Blood pressure, cognition, dementia, ethnic groups, Hispanic Americans, Clinical Sciences, Cognitive Sciences, Neurology & Neurosurgery, Clinical sciences, Biological psychology

الوصف: BackgroundEthnic differences in cognitive decline have been reported. Whether they can be explained by differences in systolic blood pressure (SBP) is uncertain.ObjectiveDetermine whether cumulative mean SBP levels explain differences in cognitive decline between Hispanic and White individuals.MethodsPooled cohort study of individual participant data from six cohorts (1971-2017). The present study reports results on SBP and cognition among Hispanic and White individuals. Outcomes were changes in global cognition (GC) (primary), executive function (EF) (secondary), and memory standardized as t-scores (mean [SD], 50 [10]); a 1-point difference represents a 0.1 SD difference in cognition. Median follow-up was 7.7 (Q1-Q3, 5.2-20.1) years.ResultsWe included 24,570 participants free of stroke and dementia: 2,475 Hispanic individuals (median age, cumulative mean SBP at first cognitive assessment, 67 years, 132.5 mmHg; 40.8% men) and 22,095 White individuals (60 years,134 mmHg; 47.3% men). Hispanic individuals had slower declines in GC, EF, and memory than White individuals when all six cohorts were examined. Two cohorts recruited Hispanic individuals by design. In a sensitivity analysis, Hispanic individuals in these cohorts had faster decline in GC, similar decline in EF, and slower decline in memory than White individuals. Higher time-varying cumulative mean SBP was associated with faster declines in GC, EF, and memory in all analyses. After adjusting for time-varying cumulative mean SBP, differences in cognitive slopes between Hispanic and White individuals did not change.ConclusionWe found no evidence that cumulative mean SBP differences explained differences in cognitive decline between Hispanic and White individuals.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/15c4515cTest

المؤلفون: Burke, James F., Sussman, Jeremy B., Yaffe, Kristine, Hayward, Rodney A., Giordani, Bruno J., Galecki, Andrzej T., Whitney, Rachael, Briceño, Emily M., Gross, Alden L., Elkind, Mitchell S. V., Manly, Jennifer J., Gottesman, Rebecca F., Gaskin, Darrell J., Sidney, Stephen, Levine, Deborah A.

المصدر: Circulation: Cardiovascular Quality & Outcomes; Jun2024, Vol. 17 Issue 6, p557-565, 9p

مستخلص: BACKGROUND: The large and increasing number of adults living with dementia is a pressing societal priority, which may be partially mitigated through improved population-level blood pressure (BP) control. We explored how tighter population-level BP control affects the incidence of atherosclerotic cardiovascular disease (ASCVD) events and dementia. METHODS: Using an open-source ASCVD and dementia simulation analysis platform, the Michigan Chronic Disease Simulation Model, we evaluated how optimal implementation of 2 BP treatments based on the Eighth Joint National Committee recommendations and SPRINT (Systolic Blood Pressure Intervention Trial) protocol would influence population-level ASCVD events, global cognitive performance, and all-cause dementia. We simulated 3 populations (usual care, Eighth Joint National Committee based, SPRINT based) using nationally representative data to annually update risk factors and assign ASCVD events, global cognitive performance scores, and dementia, applying different BP treatments in each population. We tabulated total ASCVD events, global cognitive performance, all-cause dementia, optimal brain health, and years lived in each state per population. RESULTS: Optimal implementation of SPRINT-based BP treatment strategy, compared with usual care, reduced ASCVD events in the United States by ≈77 000 per year and produced 0.4 more years of stroke- or myocardial infarction--free survival when averaged across all Americans. Population-level gains in years lived free of ASCVD events were greater for SPRINT-based than Eighth Joint National Committee--based treatment. Survival and years spent with optimal brain health improved with optimal SPRINT-based BP treatment implementation versus usual care: the average patient with hypertension lived 0.19 additional years and 0.3 additional years in optimal brain health. SPRINT-based BP treatment increased the number of years lived without dementia (by an average of 0.13 years/person with hypertension), but increased the total number of individuals with dementia, mainly through more adults surviving to advanced ages. CONCLUSIONS: Tighter BP control likely benefits most individuals but is unlikely to reduce dementia prevalence and might even increase the number of older adults living with dementia. [ABSTRACT FROM AUTHOR]

: Copyright of Circulation: Cardiovascular Quality & Outcomes is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Burke, James F., Copeland, Luciana L., Sussman, Jeremy B., Hayward, Rodney A., Gross, Alden L., Briceño, Emily M., Whitney, Rachael, Giordani, Bruno J., Elkind, Mitchell S. V., Manly, Jennifer J., Gottesman, Rebecca F., Gaskin, Darrell J., Sidney, Stephen, Yaffe, Kristine, Sacco, Ralph L., Heckbert, Susan R., Hughes, Timothy M., Galecki, Andrzej T., Levine, Deborah A.

المصدر: PLoS ONE; 5/16/2024, Vol. 19 Issue 5, p1-23, 23p

مصطلحات موضوعية: ALZHEIMER'S disease, HEALTH & Nutrition Examination Survey, BLOOD pressure, MONTE Carlo method, CHRONIC diseases

مستخلص: Strategies to prevent or delay Alzheimer's disease and related dementias (AD/ADRD) are urgently needed, and blood pressure (BP) management is a promising strategy. Yet the effects of different BP control strategies across the life course on AD/ADRD are unknown. Randomized trials may be infeasible due to prolonged follow-up and large sample sizes. Simulation analysis is a practical approach to estimating these effects using the best available existing data. However, existing simulation frameworks cannot estimate the effects of BP control on both dementia and cardiovascular disease. This manuscript describes the design principles, implementation details, and population-level validation of a novel population-health microsimulation framework, the MIchigan ChROnic Disease SIMulation (MICROSIM), for The Effect of Lower Blood Pressure over the Life Course on Late-life Cognition in Blacks, Hispanics, and Whites (BP-COG) study of the effect of BP levels over the life course on dementia and cardiovascular disease. MICROSIM is an agent-based Monte Carlo simulation designed using computer programming best practices. MICROSIM estimates annual vascular risk factor levels and transition probabilities in all-cause dementia, stroke, myocardial infarction, and mortality in a nationally representative sample of US adults 18+ using the National Health and Nutrition Examination Survey (NHANES). MICROSIM models changes in risk factors over time, cognition and dementia using changes from a pooled dataset of individual participant data from 6 US prospective cardiovascular cohort studies. Cardiovascular risks were estimated using a widely used risk model and BP treatment effects were derived from meta-analyses of randomized trials. MICROSIM is an extensible, open-source framework designed to estimate the population-level impact of different BP management strategies and reproduces US population-level estimates of BP and other vascular risk factors levels, their change over time, and incident all-cause dementia, stroke, myocardial infarction, and mortality. [ABSTRACT FROM AUTHOR]

: Copyright of PLoS ONE is the property of Public Library of Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Johnson, Kimson E., Li, Hanyu, Zhang, Min, Springer, Mellanie V., Galecki, Andrzej T., Whitney, Rachael T., Gottesman, Rebecca F., Hayward, Rodney A., Sidney, Stephen, Elkind, Mitchell S. V., Longstreth, W. T., Heckbert, Susan R., Gerber, Yariv, Sullivan, Kevin J., Levine, Deborah A.

المصدر: JAMA Network Open ; volume 7, issue 5, page e248502 ; ISSN 2574-3805

الوصف: Importance Stroke risk varies by systolic blood pressure (SBP), race, and ethnicity. The association between cumulative mean SBP and incident stroke type is unclear, and whether this association differs by race and ethnicity remains unknown. Objective To examine the association between cumulative mean SBP and first incident stroke among 3 major stroke types—ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH)—and explore how these associations vary by race and ethnicity. Design, Setting, and Participants Individual participant data from 6 US longitudinal cohorts (January 1, 1971, to December 31, 2019) were pooled. The analysis was performed from January 1, 2022, to January 2, 2024. The median follow-up was 21.6 (IQR, 13.6-31.8) years. Exposure Time-dependent cumulative mean SBP. Main Outcomes and Measures The primary outcome was time from baseline visit to first incident stroke. Secondary outcomes consisted of time to first incident IS, ICH, and SAH. Results Among 40 016 participants, 38 167 who were 18 years or older at baseline with no history of stroke and at least 1 SBP measurement before the first incident stroke were included in the analysis. Of these, 54.0% were women; 25.0% were Black, 8.9% were Hispanic of any race, and 66.2% were White. The mean (SD) age at baseline was 53.4 (17.0) years and the mean (SD) SBP at baseline was 136.9 (20.4) mm Hg. A 10–mm Hg higher cumulative mean SBP was associated with a higher risk of overall stroke (hazard ratio [HR], 1.20 [95% CI, 1.18-1.23]), IS (HR, 1.20 [95% CI, 1.17-1.22]), and ICH (HR, 1.31 [95% CI, 1.25-1.38]) but not SAH (HR, 1.13 [95% CI, 0.99-1.29]; P = .06). Compared with White participants, Black participants had a higher risk of IS (HR, 1.20 [95% CI, 1.09-1.33]) and ICH (HR, 1.67 [95% CI, 1.30-2.13]) and Hispanic participants of any race had a higher risk of SAH (HR, 3.81 [95% CI, 1.29-11.22]). There was no consistent evidence that race and ethnicity modified the association of cumulative mean SBP with first incident ...

الإتاحة: https://doi.org/10.1001/jamanetworkopen.2024.8502Test
https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2818247/johnson_2024_oi_240311_1713978026.97395.pdfTest

المؤلفون: Powell, Victoria D., Kumar, Navasuja, Galecki, Andrzej T., Kabeto, Mohammed, Clauw, Daniel J., Williams, David A., Hassett, Afton, Silveira, Maria J.

المساهمون: National Institute on Aging

المصدر: Journal of the American Geriatrics Society ; volume 70, issue 8, page 2225-2234 ; ISSN 0002-8614 1532-5415

الوصف: Background Pain, fatigue, and depression frequently co‐occur as a symptom cluster. While commonly occurring in those with cancer and autoimmune disease, the cluster is also found in the absence of systemic illness or inflammation. Loneliness is a common psychosocial stressor associated with the cluster cross‐sectionally. We investigated whether loneliness predicted the development of pain, fatigue, depression, and the symptom cluster over time. Methods Data from the Health and Retirement Study were used. We included self‐respondents ≥50 year‐old who had at least two measurements of loneliness and the symptom cluster from 2006–2016 ( n = 5974). Time‐varying loneliness was used to predict pain, fatigue, depression, and the symptom cluster in the subsequent wave(s) using generalized estimating equations (GEE) and adjusting for sociodemographic covariates, living arrangement, and the presence of the symptom(s) at baseline. Results Loneliness increased the odds of subsequently reporting pain (aOR 1.22, 95% CI 1.08, 1.37), fatigue (aOR 1.47, 95% CI 1.32, 1.65), depression (aOR 2.33, 95% CI 2.02, 2.68), as well as the symptom cluster (aOR 2.15, 95% CI 1.74, 2.67). The median time between the baseline and final follow‐up measurement was 7.6 years (IQR 4.1, 8.2). Conclusions Loneliness strongly predicts the development of pain, fatigue, and depression as well as the cluster of all three symptoms several years later in a large, nonclinical sample of older American adults. Future studies should examine the multiple pathways through which loneliness may produce this cluster, as well as examine whether other psychosocial stressors also increase risk. It is possible that interventions which address loneliness in older adults may prevent or mitigate the cluster of pain, fatigue, and depression.

الإتاحة: https://doi.org/10.1111/jgs.17796Test

المؤلفون: Kobayashi, Hiroki, Looker, Helen C., Satake, Eiichiro, Saulnier, Pierre Jean, Md Dom, Zaipul I., O’Neil, Kristina, Ihara, Katsuhito, Krolewski, Bozena, Galecki, Andrzej T., Niewczas, Monika A., Wilson, Jonathan M., Doria, Alessandro, Duffin, Kevin L., Nelson, Robert G., Krolewski, Andrzej S.

المصدر: Kidney International ; volume 102, issue 2, page 370-381 ; ISSN 0085-2538

الإتاحة: https://doi.org/10.1016/j.kint.2022.04.022Test
https://api.elsevier.com/content/article/PII:S0085253822003726?httpAccept=text/xmlTest
https://api.elsevier.com/content/article/PII:S0085253822003726?httpAccept=text/plainTest

المؤلفون: Levine, Deborah A., Whitney, Rachael T., Galecki, Andrzej T., Fagerlin, Angela, Wallner, Lauren P., Shore, Supriya, Langa, Kenneth M., Nallamothu, Brahmajee K., Morgenstern, Lewis B., Giordani, Bruno, Reale, Bailey K., Blair, Emilie M., Sharma, Anupriya, Kabeto, Mohammed U., Plassman, Brenda L., Zahuranec, Darin B.

المصدر: JGIM: Journal of General Internal Medicine; Nov2023, Vol. 38 Issue 14, p3134-3143, 10p

مصطلحات موضوعية: MILD cognitive impairment, CARDIOVASCULAR diseases, THERAPEUTICS, CARDIOLOGISTS, STROKE units, ISCHEMIC stroke, PHYSICIANS, OLDER patients

مستخلص: Background: Clinical guidelines recommend that older patients (65+) with mild cognitive impairment (MCI) and early-stage dementia receive similar guideline-concordant care after cardiovascular disease (CVD) events as those with normal cognition (NC). However, older patients with MCI and dementia receive less care for CVD and other conditions than those with NC. Whether physician recommendations for guideline-concordant treatments after two common CVD events, acute myocardial infarction (AMI) and acute ischemic stroke (stroke), differ between older patients with NC, MCI, and early-stage dementia is unknown. Objective: To test the influence of patient cognitive status (NC, MCI, early-stage dementia) on physicians' recommendations for guideline-concordant treatments for AMI and stroke. Design: We conducted two parallel, randomized survey studies for AMI and stroke in the US using clinical vignettes where the hypothetical patient's cognitive status was randomized between physicians. Participants: The study included cardiologists, neurologists, and generalists who care for most patients hospitalized for AMI and stroke. Main Measures: The primary outcome was a composite quality score representing the number of five guideline-concordant treatments physicians recommended for a hypothetical patient after AMI or stroke. Key Results: 1,031 physicians completed the study (58.5% response rate). Of 1,031 respondents, 980 physicians had complete information. After adjusting for physician factors, physicians recommended similar treatments after AMI and stroke in hypothetical patients with pre-existing MCI (adjusted ratio of expected composite quality score, 0.98 [95% CI, 0.94, 1.02]; P = 0.36) as hypothetical patients with NC. Physicians recommended fewer treatments to hypothetical patients with pre-existing early-stage dementia than to hypothetical patients with NC (adjusted ratio of expected composite quality score, 0.90 [0.86, 0.94]; P < 0.001). Conclusion: In these randomized survey studies, physicians recommended fewer guideline-concordant AMI and stroke treatments to hypothetical patients with early-stage dementia than those with NC. We did not find evidence that physicians recommend fewer treatments to hypothetical patients with MCI than those with NC. [ABSTRACT FROM AUTHOR]

: Copyright of JGIM: Journal of General Internal Medicine is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Powell, Victoria D., Abedini, Nauzley C., Galecki, Andrzej T., Kabeto, Mohammed, Kumar, Navasuja, Silveira, Maria J.

المساهمون: National Institute on Aging, University of Michigan

المصدر: Gerontology and Geriatric Medicine ; volume 7, page 233372142199762 ; ISSN 2333-7214 2333-7214

مصطلحات موضوعية: Geriatrics and Gerontology

الوصف: Objective: Pain, fatigue, and depression commonly co-occur as a symptom cluster in pathological inflammatory states. Psychosocial stressors such as loneliness may lead to similar states through shared mechanisms. We investigated the association of loneliness with pain, fatigue, and depression in older adults. Methods: Using Health and Retirement Study data ( N = 11,766), we measured cross-sectional prevalence of frequent, moderate to severe pain; severe fatigue; depressive symptoms; and co-occurrence of symptoms surpassing threshold levels (i.e., symptom cluster). Logistic regression models evaluated associations with loneliness. Results: Pain, fatigue, and depression were reported in 19.2%, 20.0%, and 15.3% of the total sample, respectively. The symptom cluster was seen in 4.9% overall; prevalence in lonely individuals was significantly increased (11.6% vs. 2.3%, p < .0001). After adjusting for demographic variables, loneliness associated with the symptom cluster (adjusted OR = 3.39, 95% CI = 2.91, 3.95) and each symptom (pain adjusted OR = 1.61, 95% CI = 1.48, 1.76; fatigue adjusted OR = 2.02, 95% CI = 1.85, 2.20; depression adjusted OR = 4.34, 95% CI = 3.93, 4.79). Discussion: Loneliness strongly associates with the symptom cluster of pain, fatigue, and depression. Further research should examine causal relationships and investigate whether interventions targeting loneliness mitigate pain, fatigue, and depression.

الإتاحة: https://doi.org/10.1177/2333721421997620Test

المؤلفون: Levine, Deborah A., Galecki, Andrzej T., Morgenstern, Lewis B., Zahuranec, Darin B., Langa, Kenneth M., Kabeto, Mohammed U., Okullo, Dolorence, Nallamothu, Brahmajee K., Giordani, Bruno, Reale, Bailey K., Campbell, Morgan, Lisabeth, Lynda D.

المصدر: Stroke ; volume 52, issue 6, page 2134-2142 ; ISSN 0039-2499 1524-4628

الوصف: Background and Purpose: Differences in acute ischemic stroke (AIS) treatment by cognitive status are unclear, but some studies have found patients with preexisting dementia get less treatment. We compared AIS care by preexisting cognitive status. Methods: Cross-sectional analysis of prospectively obtained data on 836 adults ≥45 with AIS from the population-based Brain Attack Surveillance in Corpus Christi project from 2008 to 2013. We compared receipt of a composite quality measure representing the percentage of 7 treatments/procedures received (ordinal scale; values, <0.75, 0.75–0.99, and 1.0), a binary defect-free quality score, and individual treatments after AIS between patients with preexisting dementia (Informant Questionnaire on Cognitive Decline in the Elderly score ≥3.44), mild cognitive impairment (MCI, score 3.1–3.43), and normal cognition (score ≤3). Results: Among patients with AIS, 42% had normal cognition (47% women; median age [interquartile range], 65 [56–76]), 32% had MCI (54% women; median age, 70 [60–78]), 26% had dementia (56% women; median age, 78 [64–85]). After AIS, 44% of patients with preexisting dementia and 55% of patients with preexisting MCI or normal cognition received defect-free care. Compared with cognitively normal patients, patients with preexisting MCI had similar cumulative odds (unadjusted cumulative odds ratio =0.99, P =0.92), and patients with preexisting dementia had 36% lower cumulative odds of receiving the composite quality measure (unadjusted cumulative odds ratio [OR]=0.64, P =0.005). However, the dementia-quality association became nonsignificant after adjusting for patient factors, namely sex, comorbidity, and body mass index (adjusted cumulative OR [acOR]=0.79, P =0.19). Independent of patient factors, preexisting MCI was negatively associated with receipt of IV tPA (intravenous tissue-type plasminogen activator; acOR=0.36, P =0.04), rehabilitation assessment (acOR=0.28, P =0.016), and echocardiogram (acOR=0.48, P <0.001). Preexisting dementia was ...

الإتاحة: https://doi.org/10.1161/strokeaha.120.032258Test