Potential Risk Factor For Dementia Research Articles

The relationship between cholesterol and cognitive function is homocysteine-dependent.

IntroductionPrevious studies have identified hyperlipidemia as a potential risk factor for dementia and Alzheimer’s disease. However, studies on cholesterol measured in late-life and cognitive function have been inconsistent. Few studies have explored nonlinear relationships or considered interactions with other biomarker measures.MethodsA cross-sectional sample of 1,889 participants from four rural counties in the People’s Republic of China was included in this analysis. Serum total cholesterol, high-density lipoprotein, triglycerides, and homocysteine levels were measured in fasting blood samples. A composite cognitive score was derived based on nine standardized cognitive test scores. Analysis of covariance models were used to investigate the association between biomarker measures and the composite cognitive scores.ResultsThere was a significant interaction between the homocysteine quartile group and the cholesterol quartile group on cognitive scores (P=0.0478). In participants with normal homocysteine levels, an inverse U-shaped relationship between total cholesterol level and cognitive score was found, indicating that both low and high cholesterol levels were associated with lower cognitive scores. In participants with high homocysteine levels, no significant association between cholesterol and cognition was found.ConclusionThe relationship between cholesterol levels and cognitive function depends upon homocysteine levels, suggesting an interactive role between cholesterol and homocysteine on cognitive function in the elderly population. Additional research is required to confirm our findings in other populations, and to explore potential mechanisms underlying the lipid–homocysteine interaction.

Etiological Pattern of Dementia in Patients Attending Dementia Clinic in a Referal Hospital

Background and objectives: Dementia is characterized by loss of or decline in memory and other cognitive abilities and reduces the lifespan of affected people. The number of people with Alzheimer’s Disease and other dementias is increasing every year because of the steady growth in the older population and stable increment in life expectancy and it is expected to increase two-fold by 2030 and three-fold by 2050.In addition to Alzheimer’s disease there are so many reversible and irreversible causes of dementia. This study was aimed to explore the different etiological factors related to dementia patients. Risk factors for dementia, co-morbid conditions were also included.
 Methods: This cross sectional study was carried out from 2009 to 2014 at dementia clinic (OPD), department of Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU). A total number of 166 dementia patients, as diagnosed by Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and confirmed by Mini Mental State Examination(MMSE) score were recruited in this study. Diagnosis of specific type of dementia was made on the basis of established criteria.
 Results: Alzheimer’s disease(32.5%) and Vascular dementia(31.9%) were the most common etiological factor followed by Mixed dementia(19.9%), PD with dementia(8.4%) and others(7.2%) like hypothyroidism, head injury, epilepsy etc. Increasing age, hypertension, diabetes mellitus, dyslipidemia, IHD, smoking are potential risk factors for dementia.
 Conclusion: This study concludes Alzheimer’s disease and Vascular dementia are almost equally occurring dementia. There are also some potential risk factors for development of dementia whose modification can bring a great change in dementia treatment and functional outcome of this group of elderly people of Bangladesh.
 Bangladesh Journal of Neuroscience 2014; Vol. 30 (2): 77-83

Using the Montreal Cognitive Assessment Scale to screen for dementia in Chinese patients with Parkinson's Disease.

BackgroundDementia is one of the most distressing and burdensome health problems associated with Parkinson's Disease (PD). The Montreal Cognitive Assessment scale (MoCA) is widely used to screen for dementia in PD patients, but the appropriate diagnostic cutoff score when used with Chinese PD patients is not known.AimDetermine a diagnostic cutoff value of the Chinese version of the MoCA (MoCA-C) for Chinese PD patients and describe the characteristics of PD patients screened positive for dementia using the MoCA-C.MethodsThe presence of dementia in 616 PD patients and 85 community controls was determined using the Movement Disorder Society Task Force criteria (the gold standard diagnosis). We administered the MoCA-C to these individuals and used a receiver operating characteristic (ROC) curve to identify the cutoff score of the MoCA-C that most efficiently identified dementia in both PD patients and community controls. Demographic and clinical characteristics of PD patients who were screened positive or negative for dementia using the MoCA-C were compared.ResultsA MoCA-C score of 23 was the optimal cutoff score for dementia in both patients and controls. Using this cutoff score, the sensitivity and specificity of the MoCA-C in PD patients were 0.70 and 0.77, respectively; the positive and negative predictive values were 0.59 and 0.85, respectively; and the overall concordance (kappa [95% confidence interval]) was 0.45 (0.39-0.52). The corresponding kappa value (concordance) in community controls was only 0.25 (0.05-0.45). Compared to PD patients who screened negative for dementia, those who screened positive for dementia were significantly impaired in all cognitive domains, including visuospatial and executive functioning, naming, attention, language, abstraction, delayed recall and orientation (all p<0.001). Among the PD patients, screening positive for dementia was independently associated with old age, low educational attainment, female gender and more severe motor impairment.ConclusionsThe commonly recommended cutoff screening score for dementia of 26 on the MoCA it too high for PD patients in China; a cutoff score of 23 is more appropriate. Potential risk factors for dementia in Chinese PD patients include older age, less education, and more severe motor symptoms of PD.

Risk Factors in Late Adolescence for Young-Onset Dementia in Men

Young-onset dementia (YOD), that is, dementia diagnosed before 65 years of age, has been related to genetic mutations in affected families. The identification of other risk factors could improve the understanding of this heterogeneous group of syndromes. To evaluate risk factors in late adolescence for the development of YOD later in life. We identified the study cohort from the Swedish Military Service Conscription Register from January 1, 1969, through December 31, 1979. Potential risk factors, such as cognitive function and different physical characteristics, were assessed at conscription. We collected other risk factors, including dementia in parents, through national register linkage. All Swedish men conscripted for mandatory military service (n=488,484) with a mean age of 18 years. Predominantly Swedish men born from January 1, 1950, through December 31, 1960. Potential risk factors for dementia based on those found in previous studies, data available, and quality of register data. All forms of YOD. During a median follow-up of 37 years, 487 men were diagnosed as having YOD at a median age of 54 years. In multivariate Cox regression analysis, significant risk factors (all P< .05) for YOD included alcohol intoxication (hazard ratio, 4.82 [95% CI, 3.83-6.05]); population-attributable risk, 0.28), stroke (2.96 [2.02-4.35]; 0.04), use of antipsychotics (2.75 [2.09-3.60]; 0.12), depression (1.89 [1.53-2.34]; 0.28), father's dementia (1.65 [1.22-2.24]; 0.04), drug intoxication other than alcohol (1.54 [1.06-2.24]; 0.03), low cognitive function at conscription (1.26 per 1-SD decrease [1.14-1.40]; 0.29), low height at conscription (1.16 per 1-SD decrease [1.04-1.29]; 0.16), and high systolic blood pressure at conscription (0.90 per 1-SD decrease [0.82-0.99]; 0.06). The population-attributable risk associated with all 9 risk factors was 68%. Men with at least 2 of these risk factors and in the lowest third of overall cognitive function were found to have a 20-fold increased risk of YOD during follow-up (hazard ratio, 20.38 [95% CI, 13.64-30.44]). In this nationwide cohort, 9 independent risk factors were identified that accounted for most cases of YOD in men. These risk factors were multiplicative, most were potentially modifiable, and most could be traced to adolescence, suggesting excellent opportunities for early prevention.

An Ironic Tragedy: Are Spouses of Persons with Dementia at Higher Risk for Dementia than Spouses of Persons without Dementia?

This issue of JAGs includes a paper by Norton et al. (2010)1 that reports a 600% greater risk of dementia in spouses of persons with dementia relative to spouses of persons without dementia even after controlling for important risk factors for dementia. The authors explain their provocative finding using three arguments previously employed to understand the higher risks of health problems seen in spouses of persons with dementia relative to spouses of persons without dementia. These include assortative mating, a shared life-style, and caregiving.2 However, no caregiver data are presented to support their argument (e.g., hours of care, length of care, caregiver distress, health habits and health problems); and this study was not designed to test the hypothesis that caregiving is a risk factor for dementia. Despite these limitations, many of the spouses of persons with dementia were probably caregivers; and, although it is not possible to conduct mediation analyses to interpret this study’s result, the literature includes several caregiver outcomes that may be postulated as reasons for the observed higher dementia risk in spouses of persons with dementia.

Dementia and its associations in type 2 diabetes mellitus: The Fremantle Diabetes Study

Background: recent studies indicate that diabetes is an important risk factor for dementia in older patients, but the cause remains unknown. Objectives: to determine whether vascular or diabetes-related risk factors predict the development of dementia in older subjects with diabetes. Patients: 63 patients with type 2 diabetes of mean age 75.3 years. Methods: Subjects were screened for cognitive impairment using the Mini-Mental State Examination (MMSE) and informants who knew the subjects answered the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE). Probable dementia was diagnosed using highly specific criteria based on the combination of both tests. Potential risk factors for dementia obtained at the time of the cognitive test and annually from a median of 3.2 years previously were examined using univariate methods and simple general linear modelling. Results: since there was a significant association between MMSE and English speaking ability, ten non-Anglo–Celt patients were excluded from the analysis. Probable dementia was diagnosed in six of the remaining 53 subjects (11%). Dementia was significantly and independently associated with higher diastolic and mean arterial blood pressure measurements over the 3 years before assessment. Blood pressure declined over this time in the patients with probable dementia and was similar to that in non-demented subjects at the time of cognitive assessment. Conclusions: these preliminary data suggest that the high rate of dementia found in older people with diabetes may be explained by the high rate of hypertension in this population.