Relationship between antihypertensive medications and cognitive impairment: Part I. review of human studies and clinical trials

Purpose of review: There is an established association between hypertension and increased risk of poor cognitive performance and dementia including Alzheimer’s disease; however, associations between antihypertensive medications (AHMs) and dementia risk are less consistent. An increased interest in AHM has resulted in expanding publications; however, none of the recent reviews are comprehensive. Our extensive review includes 15 observational and randomized controlled trials (RCTs) published over the last 5 years, assessing the relationship between AHM and cognitive impairment. Recent findings: All classes of AHM showed similar result patterns in human studies with the majority of study results reporting point estimates below one and only a small number of studies (N = 15) reporting statistically significant results in favor of a specific class. Summary: Only a small number of studies reported statistically significant results in favor of a specific class of AHM. Methodological limitations of the studies prevent definitive conclusions. Further work is now needed to evaluate the class of AHM and cognitive outcomes in future RCTs, with a particular focus on the drugs with the promising results in both animals and human observational studies

Interventions to reduce the adverse psychosocial impact of driving cessation on older adults

As a result of our aging population, the coming years will see increasing numbers of older adults faced with the prospect of giving up driving due to poor health or functional limitations. Driving cessation has been associated with negative psychosocial outcomes for older adults including restricted mobility and depression. While several studies report evaluations of interventions designed to help older adults to drive safely for longer, there is a paucity of published research concerned with the design or implementation of intervention programs intended to reduce the negative consequences of driving cessation. This paper reviews cognitive and educational interventions designed to promote older driver safety, and discusses possible approaches to the design and implementation of clinical interventions for older adults who have ceased driving. A broad framework for adaptable interventions based on the theoretical tenets of social cognitive theory, with an emphasis on planning for cessation, problem-solving and the involvement of friends and family members is proposed

Fathers as Sexuality Educators: Aspirations and Realities. An Interpretative Phenomenological Analysis

Men can play a significant role in teaching their children about sexuality but fathers’ practices and perceptions in this domain remain under explored. This study presents an Interpretative Phenomenological Analysis of eight fathers’ perceptions and practices in educating their ten-year-old children about physical maturation, reproduction and relationships. A Foucauldian analysis with a focus on governmentality and biopower revealed tensions and contradictions between the fathers’ aspirations and their realities, which appeared to be underpinned by the dynamic, contradictory, shifting, plural nature of fatherhood identities. Whilst fathers wished to adhere to the cultural imperative for father–child emotional closeness, a disparity between their ambitions and their conduct emerged. Care appeared to be a deeply gendered concept for the fathers and despite their aspirations for an intimate relationship with their children, gendered norms for motherhood and fatherhood prevailed resulting in passivity in their role as sexuality educators. The study concludes by arguing that challenges to structures and subcultural contexts, which may deter fathers from fully engaging with their sons and daughters in this aspect of communication are required

Invalid party wall awards and how to avoid them

Considers the reasons for the invalidity of party wall awards. Examines decided cases under earlier party wall legislation in the context of the Party Wall etc. Act 1996. Explains invalidity on the basis of an excess of the surveyors’ statutory authority. Defines this authority in terms of jurisdiction and power. Demonstrates the limits of the surveyors’ authority and emphasises the importance of strict compliance with statutory procedures. Concludes that surveyors should adopt an inquisitive and analytical approach to the scope of their authority to avoid the possibility of invalid awards. Echoes John Anstey’s earlier warning that surveyors should avoid a broad-brush approach to their duties which will only leave them “covered in soot”

Cumulative risk, factor analysis, and latent class analysis of childhood adversity data in a nationally representative sample

Background: Childhood adversity is a multifaceted construct that is in need of comprehensive operationalisation. Objective: The aim of this study was to explore the optimal method to operationalise a scale of adverse childhood experiences (ACEs). Participants and setting: Data were from Wave 1 of the Personality and Total Health (PATH) Through Life Project (N = 7485, 51% women). Participants from three age groups (20–25, 40–45, 60–65) retrospectively reported their childhood experiences of domestic adversity on a 17-item scale (e.g., physical abuse, verbal abuse, neglect, poverty). Methods: We compared three approaches to operationalising the 17-item scale: a cumulative risk approach, factor analysis, and latent class analysis (LCA). The cumulative risk and dimensional models were represented by a unidimensional and two-dimensional model respectively using confirmatory factor analysis (CFA). Results: The cumulative risk approach and LCA were viable approaches to operationalising ACE data in PATH. CFA of the dimensional model produced latent factors of threat and deprivation that were highly correlated, potentially leading to problems with multicollinearity when estimating associations. LCA revealed six classes of ACEs: high adversity, low adversity, low affection, authoritarian upbringing, high parental dysfunction, and moderate parental dysfunction. Conclusion: Our study found multiple latent classes within a 17-item questionnaire assessing domestic adversity. Using both the cumulative method and latent class approach may be a more informative approach when examining the relationship between ACEs and later health outcomes. Future ACE studies may benefit by considering multi-dimensional approaches to operationalising adversity

Role of dietary pattern analysis in determining cognitive status in elderly Australian adults

Principal Component Analysis (PCA) was used to determine the association between dietary patterns and cognitive function and to examine how classification systems based on food groups and food items affect levels of association between diet and cognitive function. The present study focuses on the older segment of the Australian Diabetes, Obesity and Lifestyle Study (AusDiab) sample (age 60+) that completed the food frequency questionnaire at Wave 1 (1999/2000) and the mini-mental state examination and tests of memory, verbal ability and processing speed at Wave 3 (2012). Three methods were used in order to classify these foods before applying PCA. In the first instance, the 101 individual food items asked about in the questionnaire were used (no categorisation). In the second and third instances, foods were combined and reduced to 32 and 20 food groups, respectively, based on nutrient content and culinary usage—a method employed in several other published studies for PCA. Logistic regression analysis and generalized linear modelling was used to analyse the relationship between PCA-derived dietary patterns and cognitive outcome. Broader food group classifications resulted in a greater proportion of food use variance in the sample being explained (use of 101 individual foods explained 23.22% of total food use, while use of 32 and 20 food groups explained 29.74% and 30.74% of total variance in food use in the sample, respectively). Three dietary patterns were found to be associated with decreased odds of cognitive impairment (CI). Dietary patterns derived from 101 individual food items showed that for every one unit increase in ((Fruit and Vegetable Pattern: p = 0.030, OR 1.061, confidence interval: 1.006–1.118); (Fish, Legumes and Vegetable Pattern: p = 0.040, OR 1.032, confidence interval: 1.001–1.064); (Dairy, Cereal and Eggs Pattern: p = 0.003, OR 1.020, confidence interval: 1.007–1.033)), the odds of cognitive impairment decreased. Different results were observed when the effect of dietary patterns on memory, processing speed and vocabulary were examined. Complex patterns of associations between dietary factors and cognition were evident, with the most consistent finding being the protective effects of high vegetable and plant-based food item consumption and negative effects of ‘Western’ patterns on cognition. Further long-term studies and investigation of the best methods for dietary measurement are needed to better understand diet-disease relationships in this age group

Is the Rise in Reported Dementia Mortality Real? Analysis of Multiple-Cause-of-Death Data for Australia and the United States

Official statistics in Australia and the United States show large recent increases in dementia mortality rates. In this study, we assessed whether these trends are biased by an increasing tendency of medical certifiers (predominantly physicians) to report on the death certificate that dementia was a direct cause of death. Regression models of multiple-cause-of-death data in Australia (2006-2016) and the United States (2006-2017) were constructed to adjust dementia mortality rates for changes in death certification practices. Compared with official statistics, the recent increase in adjusted age-standardized dementia death rates was less than half as large in Australia and about two-thirds as large in the United States. Further adjustment for changes in reporting of dementia anywhere on the death certificate implied even lower increases in dementia mortality. Declines in reporting of cardiovascular diseases as comorbid conditions also contributed to rises in dementia mortality rates. The increasing likelihood of dementia's being reported as directly leading to death largely explains recent increases in dementia mortality rates in both countries. However, studies have found that reported dementia on death certificates remains low compared with clinical evaluations of its prevalence. Improved guidance and training for certifiers in reporting of dementia on death certificates will help standardize mortality statistics within and between countries

A Bayesian Method to Mitigate the Effects of Unmodelled Time-Varying Systematics for 21-cm Cosmology Experiments

Radio observations of the neutral hydrogen signal from the Cosmic Dawn and Epoch of Reionisation have helped to provide constraints on the properties of the first stars and galaxies. Since this global 21-cm cosmological signal from the Cosmic Dawn is effectively constant on observing timescales and since effects resulting from systematics will vary with time, the effects of these systematics can be mitigated without the need for a model of the systematic. We present a method to account for unmodelled time-varying systematics in 21-cm radio cosmology experiments using a squared-exponential Gaussian process kernel to account for correlations between time bins in a fully Bayesian way. We find by varying the model parameters of a simulated systematic that the Gaussian process method improves our ability to recover the signal parameters by widening the posterior in the presence of a systematic and reducing the bias in the mean fit parameters. When varying the amplitude of a model sinusoidal systematic between 0.25 and 2.00 times the 21-cm signal amplitude and the period between 0.5 and 4.0 times the signal width, we find on average a 5% improvement in the root mean squared error of the fitted signal. We can use the fitted Gaussian process hyperparameters to identify the presence of a systematic in the data, demonstrating the method's utility as a diagnostic tool. Furthermore, we can use Gaussian process regression to calculate a mean fit to the residuals over time, providing a basis for producing a model of the time-varying systematic.Comment: 11 pages, 13 figure

Childhood adversity is associated with anxiety and depression in older adults: A cumulative risk and latent class analysis

Background: The long-lasting influence of childhood adversity on mental health is well documented; however empirical research examining how this association extends into older adults is limited. This study operationalises adversity using cumulative risk and latent class analysis (LCA) models to assess how adversity exposure and typologies may predict anxiety and depression in older adults. Methods: Data came from the Personality and Total Health (PATH) Through Life Project (N = 2551, age 60–66). Participants retrospectively reported their childhood experiences of domestic adversity on a 17-item scale. Mental health was measured using four validated questionnaires of depression and anxiety. Results: Linear and generalised additive models (GAM) indicated a dose-response relationship, where a greater number of cumulative adversities were associated with poorer scores on all four mental health measures. LCA identified a four-class solution; with high adversity and high parental dysfunction being associated with poorer mental health outcomes while moderate parental dysfunction and low adversity groups scored at healthy levels. Women reported higher overall anxiety than men, but no notable interactions between ACEs and gender were observed. Patterns revealed by LCA were similar to patterns shown by the cumulative risk model. Limitations: There is a large time gap from childhood to assessment, making our study susceptible to recall bias. Also, our findings were based on cross-sectional data, limiting causal inferences. Conclusion: Childhood adversity had independent and additive contributions to depression and anxiety in older adulthood, and both cumulative risk and person-centred approaches captured this relationship