Using magnetic resonance imaging to measure head muscles: An innovative method to opportunistically determine muscle mass and detect sarcopenia

Background Sarcopenia is associated with multiple adverse outcomes. Traditional methods to determine low muscle mass for the diagnosis of sarcopenia are mainly based on dual-energy X-ray absorptiometry (DXA), whole-body magnetic resonance imaging (MRI) and bioelectrical impedance analysis. These tests are not always available and are rather time consuming and expensive. However, many brain and head diseases require a head MRI. In this study, we aim to provide a more accessible way to detect sarcopenia by comparing the traditional method of DXA lean mass estimation versus the tongue and masseter muscle mass assessed in a standard brain MRI. Methods The H70 study is a longitudinal study of older people living in Gothenburg, Sweden. In this cross-sectional analysis, from 1203 participants aged 70 years at baseline, we included 495 with clinical data and MRI images available. We used the appendicular lean soft tissue index (ALSTI) in DXA images as our reference measure of lean mass. Images from the masseter and tongue were analysed and segmented using 3D Slicer. For the statistical analysis, the Spearman correlation coefficient was used, and concordance was estimated with the Kappa coefficient. Results The final sample consisted of 495 participants, of which 52.3% were females. We found a significant correlation coefficient between both tongue (0.26) and masseter (0.33) with ALSTI (P < 0.001). The sarcopenia prevalence confirmed using the alternative muscle measure in MRI was calculated using the ALSTI (tongue = 2.0%, masseter = 2.2%, ALSTI = 2.4%). Concordance between sarcopenia with masseter and tongue versus sarcopenia with ALSTI as reference has a Kappa of 0.989 (P < 0.001) for masseter and a Kappa of 1 for the tongue muscle (P < 0.001). Comorbidities evaluated with the Cumulative Illness Rating Scale were significantly associated with all the muscle measurements: ALSTI (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.07–1.26, P < 0.001), masseter (OR 1.16, 95% CI 1.07–1.26, P < 0.001) and tongue (OR 1.13, 95% CI 1.04–1.22, P = 0.002); the higher the comorbidities, the higher the probability of having abnormal muscle mass. Conclusions ALSTI was significantly correlated with tongue and masseter muscle mass. When performing the sarcopenia diagnostic algorithm, the prevalence of sarcopenia calculated with head muscles did not differ from sarcopenia calculated using DXA, and almost all participants were correctly classified using both methods.publishedVersio

Association between systolic blood pressure and dementia in the Whitehall II cohort study: role of age, duration, and threshold used to define hypertension

Aims To examine associations of diastolic and systolic blood pressure (SBP) at age 50, 60, and 70 years with incidence of dementia, and whether cardiovascular disease (CVD) over the follow-up mediates this association. Methods and results Systolic and diastolic blood pressure were measured on 8639 persons (32.5% women) from the Whitehall II cohort study in 1985, 1991, 1997, and 2003. Incidence of dementia (n dementia/n total = 385/8639) was ascertained from electronic health records followed-up until 2017. Cubic splines using continuous blood pressure measures suggested SBP >= 130 mmHg at age 50 but not at age 60 or 70 was associated with increased risk of dementia, confirmed in Cox regression analyses adjusted for sociodemographic factors, health behaviours, and time varying chronic conditions [hazard ratio (HR) 1.38; 95% confidence interval (95% CI) 1.11, 1.70]. Diastolic blood pressure was not associated with dementia. Participants with longer exposure to hypertension (SBP >= 130 mmHg) between mean ages of 45 and 61 years had an increased risk of dementia compared to those with no or low exposure to hypertension (HR 1.29, 95% CI 1.00, 1.66). In multi-state models, SBP >= 130 mmHg at 50 years of age was associated with greater risk of dementia in those free of CVD over the follow-up (HR 1.47, 95% CI 1.15, 1.87). Conclusion Systolic blood pressure >= 130 mmHg at age 50, below the conventional >= 140 mmHg threshold used to define hypertension, is associated with increased risk of dementia; in these persons this excess risk is independent of CVD

Determinants of cognitive performance and decline in 20 diverse ethno-regional groups: A COSMIC collaboration cohort study.

BACKGROUND: With no effective treatments for cognitive decline or dementia, improving the evidence base for modifiable risk factors is a research priority. This study investigated associations between risk factors and late-life cognitive decline on a global scale, including comparisons between ethno-regional groups. METHODS AND FINDINGS: We harmonized longitudinal data from 20 population-based cohorts from 15 countries over 5 continents, including 48,522 individuals (58.4% women) aged 54-105 (mean = 72.7) years and without dementia at baseline. Studies had 2-15 years of follow-up. The risk factors investigated were age, sex, education, alcohol consumption, anxiety, apolipoprotein E ε4 allele (APOE*4) status, atrial fibrillation, blood pressure and pulse pressure, body mass index, cardiovascular disease, depression, diabetes, self-rated health, high cholesterol, hypertension, peripheral vascular disease, physical activity, smoking, and history of stroke. Associations with risk factors were determined for a global cognitive composite outcome (memory, language, processing speed, and executive functioning tests) and Mini-Mental State Examination score. Individual participant data meta-analyses of multivariable linear mixed model results pooled across cohorts revealed that for at least 1 cognitive outcome, age (B = -0.1, SE = 0.01), APOE*4 carriage (B = -0.31, SE = 0.11), depression (B = -0.11, SE = 0.06), diabetes (B = -0.23, SE = 0.10), current smoking (B = -0.20, SE = 0.08), and history of stroke (B = -0.22, SE = 0.09) were independently associated with poorer cognitive performance (p < 0.05 for all), and higher levels of education (B = 0.12, SE = 0.02) and vigorous physical activity (B = 0.17, SE = 0.06) were associated with better performance (p < 0.01 for both). Age (B = -0.07, SE = 0.01), APOE*4 carriage (B = -0.41, SE = 0.18), and diabetes (B = -0.18, SE = 0.10) were independently associated with faster cognitive decline (p < 0.05 for all). Different effects between Asian people and white people included stronger associations for Asian people between ever smoking and poorer cognition (group by risk factor interaction: B = -0.24, SE = 0.12), and between diabetes and cognitive decline (B = -0.66, SE = 0.27; p < 0.05 for both). Limitations of our study include a loss or distortion of risk factor data with harmonization, and not investigating factors at midlife. CONCLUSIONS: These results suggest that education, smoking, physical activity, diabetes, and stroke are all modifiable factors associated with cognitive decline. If these factors are determined to be causal, controlling them could minimize worldwide levels of cognitive decline. However, any global prevention strategy may need to consider ethno-regional differences

Sex differences in dementia risk and risk factors: Individual‐participant data analysis using 21 cohorts across six continents from the COSMIC consortium

Introduction: Sex differences in dementia risk, and risk factor (RF) associations with dementia, remain uncertain across diverse ethno‐regional groups. Methods: A total of 29,850 participants (58% women) from 21 cohorts across six continents were included in an individual participant data meta‐analysis. Sex‐specific hazard ratios (HRs), and women‐to‐men ratio of hazard ratios (RHRs) for associations between RFs and all‐cause dementia were derived from mixed‐effect Cox models. Results: Incident dementia occurred in 2089 (66% women) participants over 4.6 years (median). Women had higher dementia risk (HR, 1.12 [1.02, 1.23]) than men, particularly in low‐ and lower‐middle‐income economies. Associations between longer education and former alcohol use with dementia risk (RHR, 1.01 [1.00, 1.03] per year, and 0.55 [0.38, 0.79], respectively) were stronger for men than women; otherwise, there were no discernible sex differences in other RFs. Discussion: Dementia risk was higher in women than men, with possible variations by country‐level income settings, but most RFs appear to work similarly in women and men

Analysis of factors of importance for drug use

Background: There are differences in drug use depending on non-medical factors such as age, gender and socioeconomic status. The combined effect of these factors, with adjustment for multimorbidity, is highly relevant to study to ensure equality in drug use. Objectives: 1. To examine drug use related to age, gender, income and education after adjustment for multimorbidity, in an entire adult population and in a population where prescription drugs were issued only by general practitioners. 2. To analyse if gender-related morbidity explains the differences in drug use. 3. To examine to what extent the elderly may lack indication for treatment. Methods: Register-based methods were applied in all papers, using data from Östergötland County. To estimate multimorbidity the ACG-Case Mix was used in all papers. Drug use depending on age, gender, income- and educational level, after adjustment for multimorbidity, was analysed in the entire adult population in Paper I, and in the primary healthcare population in Paper III. In Paper II diseases tending to afflict females more frequently were identified, together with the prescription drugs used to treat these diseases. Drug use was analysed before and after exclusion of these identified prescription drugs. In Paper IV the proportion of patients 65 years or older having indication for a number of their prescription drugs, identified as inappropriate for elderly, was examined, with further analysis of what may affect the result. Results: Significant differences in drug use were identified depending on age, gender, income and education, despite adjustment for multimorbidity. The elderly, females and individuals with the lowest levels of income and education had higher drug use. The differences persisted when drug use in primary healthcare was examined. The gender difference in drug use decreased when prescription drugs used to treat diseases afflicting females more often were excluded from the analyses. Less than half of the patients’ prescription drugs (45.1%), studied in Paper IV had indication for treatment. The oldest patients had to the lowest extent indication for treatment. Conclusion: The patients’ age, gender, income and education affect the drug use, despite adjustment for multimorbidity. Gender-related morbidity seems to explain some of the gender difference in drug use, and lack of indication for treatment among the elderly explains some of the age difference

Self-assessment and subsequent external review as an effective model for improving drug use for elderly in primary care : A descriptive study of SÄKLÄK2

Rationale, Aims, and Objectives: Primary health care often has overall responsibility for elderly patients and their medication treatment. This is a challenging task due to the issue of multiple caregivers, different systems for documentation and multimorbidity among the elderly. The multiprofessional project SÄKLÄK2 was developed to raise drug safety in Swedish primary health care, and this study aimed to assess whether the action agreements that emerged from the model were effective enough to potentially improve drug use in elderly patients. Method: The SÄKLÄK2 project was conducted during 2016. A total of 12 primary health care centres (PHCs) in three counties participated in the project. The intervention method concerned the management of the PHCs and comprised self-assessment, peer review, feedback, and written agreements for change, which were concluded between the reviewers and the manager of the PHC. The action agreements were analysed using summative content analysis (sorted under predesigned categories) and were also assessed as fulfilled, initiated, or not fulfilled within the follow-up time. Results: The importance of securing an accurate medication list was reflected in the number of action agreements in this area. Other prominent improvement areas were follow-up of prescriptions, pharmacogeriatric further education, and cooperation between caregivers. Action agreements to facilitate for the patient to be able to handle his/her drugs were also common. The great majority (88%) of the action agreements were implemented or initiated within the follow-up time. Conclusions: The SÄKLÄK2 intervention model is considered effective in setting up a variety of relevant measures to improve drug safety in primary health care, which are possible to implement in the near future. Hence, the model is regarded as effective and should therefore be offered in a wider context