On the Origin of Dementia : a Population Perspective on Risk and Aetiology

Recent years have seen a surge in dementia research, with increasing awareness that preventive strategies are key to curbing the dementia epidemic. Drawing from long-term population-based studies, this thesis describes the burden of dementia in terms of (healthy) life years lost, lifetime risk of developing disease, and the past and potential effects of preventive interventions on dementia incidence. Furthermore, the role of (disturbances in) cerebral blood flow, for instance due to carotid artery stenosis, and that of cerebral autoregulatory mechanisms in the onset of dementia is extensively discussed. In the subsequent chapter, a literature review that ties coronary heart disease and heart failure to the risk of dementia is followed by exploration of potential underlying mechanisms, including thromboembolic disease (e.g. Von Willebrand factor and ADAMTS13), (vascular) amyloid-β, and aortic valve calcification. Finally, the heritability of dementia and Alzheimer’s disease is yielded for both aetiological and predictive purposes. In particular, the role of the Apolipoprotein E (APOE) gene is described in mortality and for clinical trial design, followed by the use of parental family history and common genetic variants for risk prediction. This thesis concludes with methodological considerations and recommendations – or rather a wish list – for future research to strive and take dementia into the realm of forgotten diseases

Erratum to: Epidemiology of Dementia: The Burden on Society, the Challenges for Research

The name of the Chapter 1 author had been inadvertently mentioned as M. Arfan Ikram. This has been corrected and the name has been correctly updated to Ikram MA

Orthostatic Hypotension and the Long-Term Risk of Dementia: A Population-Based Study

Background: Orthostatic hypotension (OH) is a common cause of transient cerebral hypoperfusion in the population. Cerebral hypoperfusion is widely implicated in cognitive impairment, but whether OH contributes to cognitive decline and dementia is uncertain. We aimed to determine the association between OH and the risk of developing dementia in the general population. Methods and Findings: Between 4 October 1989 and 17 June 1993, we assessed OH in non-demented, stroke-free participants of the population-based Rotterdam Study. OH was defined as a ≥20 mm Hg drop in systolic blood pressure (SBP) or ≥10 mm Hg drop in diastolic blood pressure (DBP) within 3 min from postural change. We furthermore calculated within participant variability in SBP related to postural change, expressed as coefficient of variation. Follow-up for dementia was conducted until 1 January 2014. We determined the risk of dementia in relation to OH and SBP variability, using a Cox regression model, adjusted for age; sex; smoking status; alcohol intake; SBP; DBP; cholesterol:high-density lipoprotein ratio; diabetes; body mass index; use of antihypertensive, lipid-lowering, or anticholinergic medication; and apolipoprotein E genotype. Finally, we explored whether associations varied according to compensatory increase in heart rate. Among 6,204 participants (mean ± standard deviation [SD] age 68.5 ± 8.6 y, 59.7% female) with a median follow-up of 15.3 y, 1,176 developed dementia, of whom 935 (79.5%) had Alzheimer disease and 95 (8.1%) had vascular dementia. OH was associated with an increased risk of dementia (adjusted hazard ratio [aHR] 1.15, 95% CI 1.00–1.34, p = 0.05), which was similar for Alzheimer disease and vascular dementia. Similarly, greater SBP variability with postural change was associated with an increased risk of dementia (aHR per SD increase 1.08, 95% CI 1.01–1.16, p = 0.02), which was similar when excluding those who fulfilled the formal criteria for OH (aHR 1.08, 95% CI 1.00–1.17, p = 0.06). The risk of dementia was particularly increased in those with OH who lacked a compensatory increase in heart rate (within lowest quartile of heart rate response: aHR 1.39, 95% CI 1.04–1.85, p-interaction = 0.05). Limitations of this study include potential residual confounding despite rigorous adjustments, and potentially limited generalisability to populations not of European descent. Conclusions: In this population predominantly of European descent, OH was associated with an increase in long-term risk of dementia

Doped SbTe phase change material in memory cells

Phase Change Random Access Memory (PCRAM) is investigated as replacement for Flash. The memory concept is based on switching a chalcogenide from the crystalline (low ohmic) to the amorphous (high ohmic) state and vice versa. Basically two memory cell concepts exist: the Ovonic Unified Memory (OUM) and the line cell. Switching to the high ohmic or low ohmic state is done using Joule heating. A relatively short (~ns) electrical pulse with large amplitude is used to heat the crystalline phase to melt and quench into the amorphous state (RESET). A pulse with smaller amplitude heats the amorphous region above its crystallization temperature (lower than the melting temperature) and the material returns into the crystalline state (SET). In the OUM cell this will be at the electrode-phase change material contact, whereas for the line cell this will be at the position where the current density is the highest

Higher education is associated with a lower risk of dementia after a stroke or TIA

__Background:__ Higher education is associated with a lower risk of dementia, possibly because of a higher tolerance to subclinical neurodegenerative pathology. Whether higher education also protects against dementia after clinical stroke or transient ischemic attack (TIA) remains unknown. __Methods:__ Within the population-based Rotterdam Study, 12,561 participants free of stroke, TIA and dementia were followed for occurrence of stroke, TIA and dementia. Across the levels of education, associations of incident stroke or TIA with subsequent development of dementia and differences in cognitive decline following stroke or TIA were investigated. __Results:__ During 124,862 person-years, 1,463 persons suffered a stroke or TIA, 1,158 persons developed dementia, of whom 186 developed dementia after stroke or TIA. Risk of dementia after a stroke or TIA, compared to no stroke or TIA, was highest in the low education category (hazards ratio [HR] 1.46, 95% CI 1.18-1.81) followed by intermediate education category (HR 1.36, 95% CI 1.03-1.81). No significant association was observed in the high education category (HR 0.62, 95% CI 0.25-1.54). In gender stratified analyses, decrease in risk of dementia with increasing education was significant only in men. __Conclusion:__ Higher education is associated with a lower risk of dementia after stroke or TIA, particularly in men, which might be explained by a higher cognitive reserve

Plasma amyloid-β levels, cerebral atrophy and risk of dementia: A population-based study

Background: Plasma amyloid-β (Aβ) levels are increasingly studied as a potential accessible marker of cognitive impairment and dementia. However, it remains underexplored whether plasma Aβ levels including the novel Aβ peptide 1-38 (Aβ1-38) relate to preclinical markers of neurodegeneration and risk of dementia. We investigated the association of plasma Aβ1-38, Aβ1-40, and Aβ1-42 levels with imaging markers of neurodegeneration and risk of dementia in a prospective population-based study. Methods: We analyzed plasma Aβ levels in 458 individuals from the Rotterdam Study. Brain volumes, including gray matter, white matter, and hippocampus, were computed on the basis of 1.5-T magnetic resonance imaging (MRI). Dementia and its subtypes were defined on the basis of internationally accepted criteria. Results: A total of 458 individuals (mean age, 67.8 ± 7.7 yr; 232 [50.7%] women) with baseline MRI scans and incident dementia were included. The mean ± SD values of Aβ1-38, Aβ1-40, and Aβ1-42 (in pg/ml) were 19.4 ± 4.3, 186.1 ± 35.9, and 56.3 ± 6.2, respectively, at baseline. Lower plasma Aβ1-42 levels were associated with smaller hippocampal volume (mean difference in hippocampal volume per SD decrease in Aβ1-42 levels, - 0.13; 95% CI, - 0.23 to - 0.04; p = 0.007). After a mean follow-up of 14.8 years (SD, 4.9; range, 4.1-23.5 yr), 79 persons developed dementia, 64 of whom were diagnosed with Alzheimer's disease (AD). Lower levels of Aβ1-38 and Aβ1-42 were associated with increased risk of dementia, specifically AD (HR for AD per SD decrease in Aβ1-38 levels, 1.39; 95% CI, 1.00-2.16; HR for AD per SD decrease in Aβ1-42 levels, 1.35; 95% CI, 1.05-1.75) after adjustment for age, sex, education, cardiovascular risk factors, apolipoprotein E ϵ4 allele carrier status, and other Aβ isoforms. Conclusions: Our results show that lower plasma Aβ levels were associated with risk of dementia and incident AD. Moreover, lower plasma Aβ1-42 levels were related to smaller hippocampal volume. These results suggest that plasma Aβ1-38 and Aβ1-42 maybe useful biomarkers for identification of individuals at risk of dementia

Von Willebrand factor and ADAMTS13 activity in relation to risk of dementia

Low ADAMTS13 activity is associated with an increased risk of cardiovascular disease, which is generally attributed to its proteolytic effects on Von Willebrand factor (VWF). Cardiovascular health is an important determinant of cognitive decline, but the association of either VWF or ADAMTS13 with risk of dementia is unknown. Between 1997-2002, we measured VWF antigen and ADAMTS13 activity in 6055 participants of the population-based Rotterdam Study (mean age 69.3 years, 57.2% women). At baseline, 85 participants had dementia, and during 15 years of follow-up 821 developed dementia. Higher VWF was associated with prevalence and risk of dementia, unaffected by concurrent ADAMTS13 activity, but estimates strongly attenuated over time and were no longer statistically significant at 4 years of follow-up (relative risks [95% CI] per standard deviation increase- cross-sectional: 1.37 [1.06-1.77], and longitudinal: 1.05 [0.97-1.14]). In contrast, low ADAMTS13 was associated with increased risk of dementia throughout follow-up (hazard ratio per SD decrease- 1.16 [1.06-1.28]), which alike for ischaemic stroke, was modified by the presence of diabetes (P-interaction = 0.003). In conclusion, higher VWF and low ADAMTS13 activity are associated with increased risk of dementia, but differences in time-course and lack of synergistic effects may indicate in part independent underlying mechanisms

Quantitative gait, cognitive decline, and incident dementia: The Rotterdam Study

Introduction: Poor gait has recently emerged as a potential prodromal feature of cognitive decline and dementia. We assessed to what extent various aspects of poor gait are independently associated with cognitive decline and incident dementia. Methods: We leveraged detailed quantitative gait (GAITRite™) and cognitive assessments in 4258 dementia-free participants (median age 67 years, 55% women) of the population-based Rotterdam Study (baseline 2009–2013). We summarized 30 gait parameters into seven mutually independent gait domains and a Global Gait score. Participants underwent follow-up cognitive assessments between 2014 and 2016 and were followed up for incident dementia until 2016 (median 4 years). Results: Three independent gait domains (Base of Support, Pace, and Rhythm) and Global Gait were associated with cognitive decline. Two independent gait domains (Pace and Variability) and Global Gait were associated with incident dementia. Associations of gait with cognitive decline and incident dementia were only present in individuals who had been cognitively unimpaired at baseline. Discussion: Poor performance on several independent gait domains precedes cognitive decline and incident dementia