Abstract We examined the association of olfaction with incident dementia and characterized this relationship by key demographic subgroups and APOE-ε4 genotype in the ARIC study. We further examined how change in olfaction was associated with dementia incidence. Olfaction was evaluated using the 12-item Sniffin’ Sticks test in 4470 ARIC participants in 2011-2013 (visit 5) and in 2658 participants in 2016-2017 (visit 6). We defined olfaction as good (score 11-12), moderate (9-10), hyposmia (7-8), and anosmia (0-6). Dementia status was ascertained from 2011-2013 through 2020. Of the 4470 participants at baseline (age:75±5 years, 21% Black race, 60% women), 17% developed dementia over 10 years. In multivariable Cox models, moderate olfaction (hazard ratio (HR):1.5, 95%CI:1.3-1.9), hyposmia (HR:2.2, 95%CI:1.8-2.8), and anosmia (HR:3.5, 95%CI:2.8-4.3) were associated with higher dementia rate in a linear, monotonic manner relative to good olfaction. Findings were similar across subgroups of age, sex, race, and APOE-ε4 genotype. We also used logistic regression to estimate marginal dementia probability. We found that, on the risk difference scale, the absolute risk difference between anosmia and good olfaction was higher in APOE-ε4 carriers (0.29, 95%CI:0.20-0.37) compared to that in non-carriers (0.16, 95%CI:0.11-0.21); jointly, APOE-ε4 carriers with anosmia had the greatest cumulative dementia probability. Further, compared to participants who maintained good olfaction from visit 5 to visit 6, those with stable anosmia (HR:5.6, 95%CI:2.7-11.6) and a decline from good to anosmia (HR:4.5, 95%CI:2.2-9.4)) showed comparable associations with dementia incidence. Our study provides important data about how simple noninvasive olfaction tests may inform future dementia risk.
Abstract We examined cross-sectional associations between microstructural integrity of the brain and olfaction in 1417 participants from the ARIC Study who completed MRI scans in 2011-2013 (mean age=76±2 years, 41% male). Microstructural integrity was measured by two diffusion tensor imaging measures, fractional anisotropy (FA, higher=better) and mean diffusivity (MD, higher=worse), and olfaction by a 12-item odor-identification test. In multivariable linear regression models, higher FA in several regions was associated with better olfaction, with the strongest association in the stria terminalis [β:0.333 (95%CI:0.188, 0.478) per standard deviation (SD) higher FA]. Higher MD was associated with lower olfaction in almost all regions, but associations were strongest for some temporal sub-regions [for example, hippocampus, β:-0.796 (95%CI: -0.942, -0.651) per SD higher MD]. Our findings suggest that neuronal microstructural integrity is an important predictor of olfaction; this may also have important implications in understanding early dementia neuropathology as olfaction is affected very early in dementia.
The COVID-19 pandemic had an immense effect on the well-being of healthcare professionals. In this study, researchers utilized a quantitative cross-sectional study design to investigate the degree of compassion satisfaction and fatigue amongst respiratory therapists in the state of Mississippi as a result of providing care to patients during the COVID-19 pandemic. Quantitative data were collected using an anonymous online survey that assessed the well-being and satisfaction of licensed respiratory therapists in the state of Mississippi. More specially, survey responses (n = 326) were quantitatively evaluated to measure the association between demographic variables and compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS). Ninety-seven percent of participants reported a medium to high CS level, while 74% indicated having a medium to high level of BO, and 69% reported a medium to high level of STS. Neither age nor gender had a significant difference in CS (p = 0.504; p = 0.405), BO (p = 0.161; p = 0.285), or STS (p = 0.145; p = 0.252). Those working for more than 10 years at their current employer had higher CS (M = 38.7) and lower BO (M = 24.9) and STS (M = 24.8) scores. The number of hours worked, specifically overtime, had a significant impact on BO (β = 0.09, p = 0.028) and STS (β = 0.0.11, p = 0.019), but not CS (β = 0.02, p = 0.655). These findings suggest that the number of years employed in the field impacts the level of compassion satisfaction and contributes to lower levels of burnout and secondary traumatic stress. The age of a patient may also affect levels of compassion and burnout. The results of this study highlight the importance of developing incentive plans in an effort to retain employees.
Introduction: Sudden cardiac death (SCD) is an important public health problem. About 356,000 people suffer SCD in the U.S., accounting for 15% of all deaths. The ankle-brachial index (ABI) is a simple, non-invasive measure of subclinical atherosclerosis. The aim of this study was to determine the relation between ABI and SCD in a middle-aged biracial general population. Methods: All ARIC (Atherosclerosis Risk in Communities) study subjects with a documented ABI measurement between 1987 and 1989 were included in the study. ABI was categorized as abnormal (≤0.9), borderline (0.9-1), normal [1-1.4], and non-compressible (>1.4). SCD was defined as a sudden pulseless condition presumed to be caused by a ventricular tachyarrhythmia in a previously stable individual. All SCD cases were adjudicated by a committee of cardiac electrophysiologists, cardiologists, and internists. Results: Of the 15,135 participants followed for a median of 23.5 years, 558 (3.7%) developed SCD (1.96 cases per 1000 person-years). Abnormal or borderline ABIs were associated with an elevated risk of SCD (HRs with 95 % CIs 2.27 [1.64-3.14] and 1.52 [1.17-1.96], respectively) in comparison to normal ABI. The association between abnormal ABI and SCD remained significant after adjustment for traditional cardiovascular risk factors, but not for borderline ABI (HR 1.63 [1.15-2.32] and 1.24 [0.94-1.63]) (Table). Conclusions: Abnormal ABI is independently associated with risk of SCD in a biracial general population. ABI could be incorporated into a future risk SCD prediction model.
Key Points A total of 8.42 million US adults have high CKD progression risk, and 4.77 million of them have eGFR >60 ml/min per 1.73 m 2 . An individual's absolute risk of CKD progression is important in the diagnosis and prognostication of CKD. Background CKD is currently defined using GFR or albuminuria. This is on the basis of the relative risk of mortality and kidney outcomes compared with a healthy population and does not consider an individual's absolute risk of CKD progression. Methods Using National Health and Nutrition Examination Survey data from 1999 to 2020, we characterized the individual-level absolute 3-year risk of ≥40% decline in eGFR (ml/min per 1.73 m 2 ) or kidney failure (3-year risk) among US adults. We categorized the 3-year risk and considered ≥5% as high risk. Results Among 199.81 million US adults, 8.42 million (4%) had a 3-year risk ≥5%, including 1.04 million adults without CKD (eGFR ≥60 and albuminuria <30 mg/g). These high-risk adults without CKD as currently defined had risk factors including hypertension (98%), heart failure (72%), and diabetes (44%). A total of 15.51 million adults had CKD with preserved eGFR (eGFR ≥60 and albuminuria ≥30 mg/g)—3.73 million had a 3-year risk ≥5%, 41% of whom did not have diabetes and thus would not be screened for albuminuria using current screening recommendations. The 3-year risk of CKD progression was low (risk <5%) in 94% of the 5.66 million US adults with CKD stage G3a-A1 (eGFR 45 to <60 and albuminuria <30 mg/g). Conclusions Assessment of the individual's absolute risk of CKD progression allowed further risk stratification of patients with CKD and identified individuals without CKD, as currently defined, who were at high risk of CKD progression. Podcast This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/JASN/2024_06_18_ASN0000000000000377.mp3
Abstract We examined the associations between lung function and incident dementia and cognitive decline in 12,688 participants in the ARIC Study who provided lung function measurements in 1990–1992. Cognitive tests were administered up to 7 times, and dementia was ascertained through 2019. We used shared parameter models to jointly fit proportional hazard models and linear mixed-effect models to estimate lung-function–associated dementia rate and cognitive change, respectively. Higher forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were associated with reduced dementia (n = 2,452 persons developed dementia); hazard ratios per 1-L increase in FEV1 and FVC were 0.79 (95% confidence interval (CI): 0.71, 0.89) and 0.81 (95% CI: 0.74, 0.89), respectively. Each 1-L increase in FEV1 and FVC was associated with a 0.08–standard deviation (SD) (95% CI: 0.05, 0.12) and a 0.05-SD (95% CI: 0.02, 0.07) attenuation of 30-year cognitive decline, respectively. A 1% increase in FEV1/FVC ratio was associated with 0.008-SD (95% CI: 0.004, 0.012) less cognitive decline. We observed statistical interaction between FEV1 and FVC, suggesting that cognitive declines depended on values of specific FEV1 and FVC (as compared with FEV1, FVC, or FEV1/FVC ratio models that suggested linear incremental associations). Our findings may have important implications for reducing the burden of cognitive decline that is attributable to environmental exposures and associated lung function impairment.
Empathy is crucial for our social life, with evidences suggesting that executive function is the cognitive basis of empathy. However, debates about the causal relationship between executive function and empathy still exist. A two-wave and one-year longitudinal follow-up experiment is conducted to investigate this problem, mainly focusing on preschoolers as executive function and empathy develop rapidly in preschoolers. A one-year cross-lagged panel analysis results found that preschoolers' empathy, mainly cognitive empathy, was predicted by inhibitory control. In line with previous studies, these results imply that inhibitory control is the cognitive basis of preschoolers' empathy and future educational practices and training studies should be considered.W
