Abstract INTRODUCTION The LIfestyle for BRAin Health (LIBRA) index yields a dementia risk score based on modifiable lifestyle factors and is validated in Western samples. We investigated whether the association between LIBRA scores and incident dementia is moderated by geographical location or sociodemographic characteristics. METHODS We combined data from 21 prospective cohorts across six continents ( N = 31,680) and conducted cohort‐specific Cox proportional hazard regression analyses in a two‐step individual participant data meta‐analysis. RESULTS A one‐standard‐deviation increase in LIBRA score was associated with a 21% higher risk for dementia. The association was stronger for Asian cohorts compared to European cohorts, and for individuals aged ≤75 years (vs older), though only within the first 5 years of follow‐up. No interactions with sex, education, or socioeconomic position were observed. DISCUSSION Modifiable risk and protective factors appear relevant for dementia risk reduction across diverse geographical and sociodemographic groups. Highlights A two‐step individual participant data meta‐analysis was conducted. This was done at a global scale using data from 21 ethno‐regionally diverse cohorts. The association between a modifiable dementia risk score and dementia was examined. The association was modified by geographical region and age at baseline. Yet, modifiable dementia risk and protective factors appear relevant in all investigated groups and regions.
<i>Background/Aims:</i> While social factors may influence the trajectories of cognitive aging, the influence of spousal characteristics (i.e. health or mental health) on cognitive decline has received little attention. This study examined the influence of baseline depressive symptoms in one spouse on cognitive functioning in the other. <i>Methods:</i> We conducted a longitudinal study of 279 Latino spousal pairs (558 people) taken from a cohort study (n = 1,789) in California’s central valley with assessments every 12–18 months. <i>Results:</i> Higher husband baseline depression was significantly associated with lower cognitive scores maintained across time for both husbands (p < 0.001) and wives (p = 0.01). Wives with higher baseline depression scores showed significantly worse cognitive function over time (p = 0.007). <i>Conclusions:</i> Husbands’ cognitive function was more strongly linked to their own level of depression, whereas wives’ cognitive function was influenced by both their own and their partners’ level of baseline depression. Our study further documents the public health significance of depression and our need to look beyond the individual to the reverberating effects of depression on the family.
Background: Stroke is a leading cause of death in the United States and has been linked to an increased risk of dementia and cognitive impairment. The prevalence of stroke and vascular risk factors are higher among Mexican Americans than non-Hispanic whites, but the literature on stroke and dementia and cognitive impairment among this growing ethnic group remains largely unexplored. Objective: We evaluated the association between non-fatal stroke and incidence of dementia/cognitive impairment without dementia (CIND) in a cohort of older Mexican Americans, accounting for the competing risk of mortality. Methods: The present study included 1,617 participants from the Sacramento Area Latino Study on Aging (SALSA), a population-based study of Mexican Americans aged 60-98 years, who were free of dementia/CIND at baseline in 1998-1999 and followed through 2007. At annual study visits, stroke events were identified by self-report of a physician diagnosis or hospitalization and dementia and CIND cases were identified with a three-phase clinical assessment protocol. We evaluated the association between baseline and time dependent stroke and incidence of dementia/CIND with Fine and Gray competing risk regression models to account for the competing risk of mortality. Results: There were 221 participants with a history of stroke at baseline or who experienced a non-fatal stroke during the study. Over a mean follow-up of 6.5 years, there were 159 incident dementia/CIND cases and 298 deaths (n=61 deaths due to stroke). After accounting for the competing risk of mortality and adjusting for sex, education, waist circumference, diabetes, and systolic blood pressure, individuals with a stroke event had a three-fold increased risk of dementia/CIND compared to those with no stroke event (hazard ratio=2.97, 95% CI: 2.05-4.30). Conclusions: These results suggest that among older Mexican Americans, stroke is strongly associated with incidence of dementia/CIND, even after accounting for traditional vascular risk factors and the competing risk of mortality.
Type 2 diabetes has been linked with increased risk of dementia and cognitive impairment among older adults and with premature mortality in young and middle-aged adults. No studies have evaluated the association between diabetes and dementia among Mexican Americans, a population with a high burden of diabetes. We evaluated the association of diabetes with incidence of dementia and cognitive impairment without dementia (CIND) among older Mexican Americans while accounting for competing risk from death.This study included 1,617 participants 60-98 years of age from the Sacramento Area Latino Study on Aging followed up to 10 years from 1998. We evaluated the association between diabetes and dementia/CIND with competing risk regression models.Participants free of dementia/CIND at baseline (n = 1,617) were followed annually up to 10 years. There were 677 (41.9%) participants with diabetes, 159 (9.8%) incident dementia/CIND cases, and 361 (22.3%) deaths. Treated and untreated diabetes (hazard ratio 2.12 [95% CI 1.65-2.73] and 2.15 [1.58-2.95]) and dementia/CIND (2.48 [1.75-3.51]) were associated with an increased risk of death. In models adjusted for competing risk of death, those with treated and untreated diabetes had an increased risk of dementia/CIND (2.05 [1.41-2.97] and 1.55 [0.93-2.58]) compared with those without diabetes.These findings provide evidence that the association between type 2 diabetes and dementia/CIND among Mexican Americans remains strong after accounting for competing risk of mortality. Treatments that modify risk of death among those with diabetes may change future dementia risk.
The association between obesity and dementia has been inconsistent, possibly due to changes in body composition often seen in old age. Leptin may be associated with better cognitive function. However, neuroprotection may be inhibited among obese subjects possibly due to leptin resistance. We sought to determine (i) if leptin is associated with risk of dementia or mild cognitive impairment (MCI) in a cohort of very old women, (ii) if this association is modified by obesity, and (iii) if leptin is a stronger risk factor compared with traditional anthropometric measures. We studied 579 older women (mean age 82.6 years) from the ongoing prospective cohort Study of Osteoporotic Fractures, who were dementia-free at year-16 examination (our study baseline). Leptin (ng/mL) was measured using year-16 frozen serum, and anthropometric measures were collected during the same visit. Diagnosis of dementia/MCI was determined at year-20 examination. There was evidence for a multiplicative interaction between log leptin and categorical body mass index (p = .03). Among women with body mass index <25kg/m2 (n = 190), 1SD difference in log leptin (0.91ng/mL) was associated with 32% lower odds of dementia/MCI (OR = .68; 95% CI = .46, .99), after adjustment. The association was not significant among women with body mass index ≥25kg/m2 (n = 377). Traditional anthropometric measures such as weight, height, and body mass index were not associated with dementia/MCI. In this cohort of very old women, higher serum leptin was prospectively associated with lower odds of dementia/MCI in women with normal body mass index, but not in overweight or obese women. Leptin may be a better predictor of dementia/MCI than traditional anthropometric measures.
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