Early parental death and psychosocial risk factors for dementia: A case-control study in Europe

Objectives: To assess the association between early parental death and the risk of dementia in adult life, and to examine the risk factors associated with early parental death in people with and without dementia. Methods / Design: A population-based case-control study of a sample of 65,997 participants from the Survey of Health, Ageing and Retirement in Europe study. Early parental death was operationalized as parental death at the age of ≤ 16 years. Main analyses were conducted using bivariate and multivariate logistic regression analyses. Results: The odds ratio (OR) for dementia in individuals who experienced early parental death (father or mother) at the age of ≤ 16 years was 1.83 (95%CI 1.61-2.09) and 1.54 (95%CI 1.35-1.76) adjusted for age, gender, and education. In the multivariate logistic regression analysis carried out with the whole sample, early parental death increased the risk of dementia (OR = 1.50, 95%CI 1.31-1.72), along with older age (OR = 5.92, 95%CI 4.86-7.17), neuroticism (OR = 2.94,95%CI 2.61-3.31), low education level (OR = 1.84, 95%CI 1.64- 2.05) and low income (OR = 1.49, 95%CI 1.34-1.67). Discussion: Early parental death (< 16 years) was associated with an increased risk of dementia. We discuss the neurobiological markers associated with adverse childhood experiences (ACEs) and dementia as well as interventions to counteract the negative health effects on adults

Causes, mortality rates and risk factors of death in community-dwelling Europeans aged 50 years and over: Results from the Survey of Health, Ageing and Retirement in Europe 2013-2015

Objective: To determine mortality rates and to rank the causes and predictors of mortality using a wide range of sociodemographic and clinical variables. Materials and Methods: It is a prospective population-based cohort study of adults living in the community, 2013-15 (N = 48,691, age ≥50; deceased = 1,944). Clinical and sociodemographic data were obtained from the Survey of Health, Ageing and Retirement in Europe (SHARE): Age, Gender, Marital Status, Years of Schooling, Income, Loneliness, Cognition, Self-Rated Health, Diseases, Activities of daily living (ADL), Frailty and Mobility. Mortality rates were calculated. A Cox proportional hazards model were used to determine risk-adjusted mortality ratios with confidence intervals (99% CI). Results: The crude mortality rate was 18.39 (1000 person-years at risk), (99% CI, 18.37-18.42). The factors most associated with an increased mortality risk were older age, lower self-rated health, lower cognition, male gender, ADL deficits, higher comorbidity, frailty and loneliness. The diseases with a higher mortality risk were: cancer (Hazard ratio, HR = 2.67), dementia (HR = 2.19), depressive symptoms (HR = 2.10), fractures (hip, femur) (HR = 1.57), stroke (HR = 1.55), chronic lung disease (HR = 1.52), diabetes (HR = 1.36) and heart attack (HR = 1.21). Conclusions: The main mortality risk factors, associated independently in the eight diseases were: older age, poor self-rated health, ADL deficits, male gender, lower cognition, comorbidity and the presence of depressive symptoms. The need to evaluate and treat the depressive symptoms that accompanies diseases with higher risk of mortality is stressed

Real-world evidence in Alzheimer’s disease: the ROADMAP Data Cube

INTRODUCTION:The ROADMAP project aimed to provide an integrated overview of European real-world data on Alzheimer's disease (AD) across the disease spectrum. METHODS:Metadata were identified from data sources in catalogs of European AD projects. Priority outcomes for different stakeholders were identified through systematic literature review, patient and public consultations, and stakeholder surveys. RESULTS:Information about 66 data sources and 13 outcome domains were integrated into a Data Cube. Gap analysis identified cognitive ability, functional ability/independence, behavioral/neuropsychiatric symptoms, treatment, comorbidities, and mortality as the outcomes collected most. Data were most lacking in caregiver-related outcomes. In general, electronic health records covered a broader, less detailed data spectrum than research cohorts. DISCUSSION:This integrated real-world AD data overview provides an intuitive visual model that facilitates initial assessment and identification of gaps in relevant outcomes data to inform future prospective data collection and matching of data sources and outcomes against research protocols

A protective personal factor against disability and dependence in the elderly: an ordinal regression analysis with nine geographically-defined samples from Spain

Background Sense of Coherence (SOC) is defined as a tendency to perceive life experiences as comprehensible, manageable and meaningful. The construct is split in three major domains: Comprehensibility, Manageability, and Meaningfulness. SOC has been associated with successful coping strategies in the face of illness and traumatic events and is a predictor of self-reported and objective health in a variety of contexts. In the present study we aim to evaluate the association of SOC with disability and dependence in Spanish elders. Methods A total of 377 participants aged 75 years or over from nine locations across Spain participated in the study (Mean age: 80.9 years; 65.3% women). SOC levels were considered independent variables in two ordinal logistic models on disability and dependence, respectively. Disability was established with the World health Organization-Disability Assessment Schedule 2.0 (36-item version), while dependence was measured with the Extended Katz Index on personal and instrumental activities of daily living. The models included personal (sex, age, social contacts, availability of an intimate confidant), environmental (municipality size, access to social resources) and health-related covariates (morbidity). Results High Meaningfulness was a strong protective factor against both disability (Odds Ratio [OR] = 0.50; 95% Confidence Interval [CI] = 0.29–0.87) and dependence (OR = 0.33; 95% CI = 0.19–0.58) while moderate and high Comprehensibility was protective for disability (OR = 0.40; 95% CI = 0.22–0.70 and OR = 0.39; 95%CI = 0.21–0.74), but not for dependence. Easy access to social and health resources was also highly protective against both disability and dependence. Conclusions Our results are consistent with the view that high levels of SOC are protective against disability and dependence in the elderly. Elderly individuals with limited access to social and health resources and with low SOC may be a group at risk for dependence and disability in Spain.This project was partially funded by a research contract in support of the project “Epidemiological Study of Dementia in Spain” signed by the Pfizer Foundation and Carlos III Institute of HealthS

Prevalence of disability in a composite ≥75 year-old population in Spain: A screening survey based on the International Classification of Functioning

<p>Abstract</p> <p>Background</p> <p>The prevalence and predictors of functional status and disability of elderly people have been studied in several European countries including Spain. However, there has been no population-based study incorporating the International Classification of Functioning, Disability and Health (ICF) framework as the basis for assessing disability. The present study reports prevalence rates for mild, moderate, and severe/extreme disability by the domains of activities and participation of the ICF.</p> <p>Methods</p> <p>Nine populations surveyed in previous prevalence studies contributed probabilistic and geographically defined samples in June 2005. The study sample was composed of 503 subjects aged ≥75 years. We implemented a two-phase screening design using the MMSE and the World Health Organization-Disability Assessment Schedule 2^ndedition (WHO-DAS II, 12 items) as cognitive and disability screening tools, respectively. Participants scoring within the positive range of the disability screening were administered the full WHO-DAS II (36 items; score range: 0-100) assessing the following areas: Understanding and communication, Getting along with people, Life activities, Getting around, Participation in society, and Self-care. Each disability area assessed by WHO-DAS II (36 items) was reported according to the ICF severity ranges (No problem, 0-4; Mild disability, 5-24; Moderate disability, 25-49; Severe/Extreme disability, 50-100).</p> <p>Results</p> <p>The age-adjusted disability prevalence figures were: 39.17 ± 2.18%, 15.31 ± 1.61%, and 10.14 ± 1.35% for mild, moderate, and severe/extreme disability, respectively. Severe and extreme disability prevalence in mobility and life activities was three times higher than the average, and highest among women. Sex variations were minimal, although life activities for women of 85 years and over had more severe/extreme disability as compared to men (OR = 5.15 95% CI 3.19-8.32).</p> <p>Conclusions</p> <p>Disability is highly prevalent among the Spanish elderly. Sex- and age-specific variations of disability are associated with particular disability domains.</p

Course of depressive symptoms and associated factors in people aged65+ in Europe: A two-year follow-up

Background: The epidemiology of depressive disorders presents notable differences among European countries. The objectives of the study are to determine the prevalence, incidence, persistence and remission rates of depressive symptoms and to identify risk factors and differences between four European regions. Method: Prospective cohort design using data from waves 5 and 6 (2013-15) of the Survey of Health, Ageing and Retirement in Europe. Sample size included 31,491 non-institutionalized adults aged 65+. Depressive symptoms were assessed using the EURO-D. Results: The prevalence of depressive symptoms (EURO-D ≥4) was 29.8% and 31.5%in waves 5 and 6, respectively. The risk factors associated depressive symptoms were poorer self-rated health, loneliness, impairment in ADL, female gender and financial difficulties. Incidence was 6.62 (99.9% CI: 6.61-6.63)/100 person-years and the persistence and remission rates were 9.22 and 5.78, respectively. Regarding the differences between European regions, the incidence (4.93 to 7.43) and persistence (5.14 to 11.86) rates followed the same ascending order: Northern, Eastern, Continental and Southern. The remission presented higher rates in the Eastern and Southern (6.60-6.61) countries than in the Northern and Continental (4.45-5.31) ones. Limitations: The EURO-D scale is unable to distinguish between clinically relevant depressive symptoms and major depression. Conclusion: The risk factors related to the incidence of depressive symptoms differed across European regions. In countries of eastern and southern Europe the most important predictors were female gender and impairment in ADL. Poorer self-rated health and older age were more relevant in the Northern countries, and chronic diseases were a key factor in the Continental region

Abridged Scale for the Screening Anosognosia in Patients With Dementia

The objective of this cross-sectional study was to validate an abridged version of the Anosognosia Questionnaire - Dementia (AQ-D). The authors reduce the AQ-D from 30 items to 9, with a large sample of Alzheimer's disease (AD) patients (n=352). The Cronbach's alpha was 0.793 and an area under the COR curve was 0.946. Kappa index between new Abridged AQ-D (AAQ) and original AQ-D was =0.800. The AAQ presents good validity and reliability indicators and kept concordance with the original scale. It's quick and easy to application and it can simplify the clinical evaluation of anosognosia in AD patients

Association of depression phenotypes and antidepressant treatment with mortality due to cancer and other causes: a community-based cohort study

ObjectiveThis study aimed to assess the association of somatic depressive symptoms (SDS), cognitive/emotional depressive symptoms (C-EDS), and antidepressant treatment on mortality due to cancer and other causes in a community cohort.MethodsA community-based sample recruited in 1995, 2000, and 2005 aged between 35 and 75 years was examined in two waves and followed for a median of 6.7 years. SDS and C-EDS phenotypes were assessed using the Patient Health Questionnaire-9. Medication used by participants was collected. Deaths and their causes were registered during follow-up. Cox proportional hazard models stratified by sex were performed to determine the association between depressive phenotypes and mortality.ResultsThe cohort consisted of 5,646 individuals (53.9% women) with a mean age of 64 years (SD = 11.89). During the follow-up, 392 deaths were recorded, of which 27.8% were due to cancer. C-EDS phenotype was associated with an increased risk of cancer mortality in both men (HR = 2.23; 95% CI = 1.11-4.44) and women (HR = 3.69; 95% CI = 1.69-8.09), and SDS was significantly associated with non-cancer mortality in men (HR = 2.16; 95 CI % = 1.46-3.18). Selective serotonin reuptake inhibitors (SSRIs) were significantly associated with both cancer (HR = 2.78; 95% CI = 1.10-6.98) and non-cancer mortality (HR = 2.94; 95% CI = 1.76-4.90) only in the male population.ConclusionC-EDS phenotype was related to an increased risk of cancer mortality at 6 years. In addition, the use of SSRIs in the male population was associated with cancer and all-cause mortality

Severity of Dementia, Anosognosia, and Depression in Relation to the Quality of Life of Patients With Alzheimer Disease: Discrepancies Between Patients and Caregivers

Objective: To investigate the factors associated with discrepancies between patient and caregiver reports of the quality of life of patients (QoLp) with Alzheimer"s disease (AD). Methods: Cross-sectional analytic study of 141 patients and their caregivers. The instruments used were the Quality of Life in AD (QoL-AD), the Global Deterioration Scale (GDS), the Geriatric Depression Scale (GDS-d) and the Anosognosia Questionnaire Dementia (AQ-D). Differences were analyzed according to GDS stage. A linear regression analysis was conducted using the difference between the absolute QoLp scores of patients and caregivers. A cluster analysis involving the patient variables was then performed. Results: The discrepancy between patient and caregiver QoLp ratings increased in line with GDS stages (χ2 (2) = 8.7, p = 0.013). In the regression model (F [7,133] = 16.6, p <0.001; R2 = 0.477), discrepancies in QoLp reports were associated with greater anosognosia, less depression and a better cognitive status in patients, as well as with female gender among caregivers. The cluster analysis showed that patients with the lowest ratings of QoLp had a better cognitive status, more depression and less anosognosia. Conversely, the highest ratings were given by patients with a poorer cognitive status, less depression and greater anosognosia. Conclusions: The factors associated with greater discrepancies between patient and caregiver ratings of QoLp were severity of dementia, anosognosia, depression and cognitive status in patients, and female gender in caregivers. In patients with advanced dementia, greater anosognosia leads to more positive ratings in QoLp and complementary observations are required