Intentional weight loss in overweight and obese individuals and cognitive function: a systematic review and meta-analysis.

High adiposity in middle age is associated with higher dementia risk. The association between weight loss and cognitive function in older adults is still controversial. A meta-analysis was undertaken to estimate the effectiveness of intentional weight loss on cognitive function in overweight and obese adults. A structured strategy was used to search randomized and non-randomized studies reporting the effect of intentional and significant weight loss on cognitive function in overweight and obese subjects. Information on study design, age, nutritional status, weight-loss strategy, weight lost and cognitive testing was extracted. A random-effect meta-analysis was conducted to obtain summary effect estimates for memory and attention-executive domains. Twelve studies met inclusion criteria. Seven were randomized trials and the remaining five included a control group. A low-order significant effect was found for an improvement in cognitive performance with weight loss in memory (effect size 0.13, 95% CI 0.00-0.26, P=0.04) and attention/executive functioning (effect size 0.14, 95% CI 0.01-0.27, P<0.001). Studies were heterogeneous in study design, sample selection, weight-loss intervention and assessment of cognitive function. Weight loss appears to be associated with low-order improvements in executive/attention functioning and memory in obese but not in overweight individual

A Novel Examination of Successful Aging Trajectories at the End of Life

A successful aging (SA) index was captured in a longitudinal population-based cohort study of individuals aged 75 and older and examined longitudinally using growth mixture modelling (GMM) to identify groups with similar trajectories using decedents' (n = 1,015) last completed interview and up to four previous data collection waves before death. GMM identified a three-class model. Classes were high-functioning, no decline (HN); high-functioning, gradual decline (HG); and low-functioning, steep decline (LS). HN class individuals were significantly younger at death (p < 0.001) and at last interview (p < 0.001), consisted of more men (p < 0.001), and more likely to be married (p < 0.001) compared to HG and LS class individuals. These results demonstrate the different ways in which individuals can experience successful aging at the end of life. This study provides the framework for future research into life-course processes of aging, with important implications for policy and practice

Is cognitive decline before death in the oldest old a universal phenomenon

We investigated the heterogeneity in end of life cognitive decline in two European longitudinal studies of the oldest old: the OCTO-Twin and the Newcastle 85+ Study. Using a coordinated analytical approach, we identified unobserved groups of individuals with similar trajectories of cognitive decline at the end of life by fitting Tobit Growth Mixture Models to Mini-Mental State Examination scores. In both studies, the current analyses consistently identified two groups of individuals whose cognitive decline at the end of life were distinct: one group did not exhibit an ostensible rate of decline, another group experienced steep decline in measures of global cognition within each study. In OCTO-Twin, accelerated decline was found in only one group. Our results showed heterogeneity in cognitive decline at the end of life in the oldest old across two different European countries and suggest that terminal decline is not necessarily a normative process

Single Gene Deletions of Orexin, Leptin, Neuropeptide Y, and Ghrelin Do Not Appreciably Alter Food Anticipatory Activity in Mice

Timing activity to match resource availability is a widely conserved ability in nature. Scheduled feeding of a limited amount of food induces increased activity prior to feeding time in animals as diverse as fish and rodents. Typically, food anticipatory activity (FAA) involves temporally restricting unlimited food access (RF) to several hours in the middle of the light cycle, which is a time of day when rodents are not normally active. We compared this model to calorie restriction (CR), giving the mice 60% of their normal daily calorie intake at the same time each day. Measurement of body temperature and home cage behaviors suggests that the RF and CR models are very similar but CR has the advantage of a clearly defined food intake and more stable mean body temperature. Using the CR model, we then attempted to verify the published result that orexin deletion diminishes food anticipatory activity (FAA) but observed little to no diminution in the response to CR and, surprisingly, that orexin KO mice are refractory to body weight loss on a CR diet. Next we tested the orexigenic neuropeptide Y (NPY) and ghrelin and the anorexigenic hormone, leptin, using mouse mutants. NPY deletion did not alter the behavior or physiological response to CR. Leptin deletion impaired FAA in terms of some activity measures, such as walking and rearing, but did not substantially diminish hanging behavior preceding feeding time, suggesting that leptin knockout mice do anticipate daily meal time but do not manifest the full spectrum of activities that typify FAA. Ghrelin knockout mice do not have impaired FAA on a CR diet. Collectively, these results suggest that the individual hormones and neuropepetides tested do not regulate FAA by acting individually but this does not rule out the possibility of their concerted action in mediating FAA

Predicting dementia from primary care records: a systematic review and meta-analysis

Introduction Possible dementia is usually identified in primary care by general practitioners (GPs) who refer to specialists for diagnosis. Only two-thirds of dementia cases are currently recorded in primary care, so increasing the proportion of cases diagnosed is a strategic priority for the UK and internationally. Clinical entities in the primary care record may indicate risk of developing dementia, and could be combined in a predictive model to help find patients who are missing a diagnosis. We conducted a meta-analysis to identify clinical entities with potential for use in such a predictive model for dementia in primary care. Methods and Findings We conducted a systematic search in PubMed, Web of Science and primary care database bibliographies. We included cohort or case-control studies which used routinely collected primary care data, to measure the association between any clinical entity and dementia. Meta-analyses were performed to pool odds ratios. A sensitivity analysis assessed the impact of non-independence of cases between studies. From a sift of 3836 papers, 20 studies, all European, were eligible for inclusion, comprising >1 million patients. 75 clinical entities were assessed as risk factors for all cause dementia, Alzheimer’s (AD) and Vascular dementia (VaD). Data included were unexpectedly heterogeneous, and assumptions were made about definitions of clinical entities and timing as these were not all well described. Meta-analysis showed that neuropsychiatric symptoms including depression, anxiety, and seizures, cognitive symptoms, and history of stroke, were positively associated with dementia. Cardiovascular risk factors such as hypertension, heart disease, dyslipidaemia and diabetes were positively associated with VaD and negatively with AD. Sensitivity analyses showed similar results. Conclusions These findings are of potential value in guiding feature selection for a risk prediction tool for dementia in primary care. Limitations include findings being UK-focussed. Further predictive entities ascertainable from primary care data, such as changes in consulting patterns, were absent from the literature and should be explored in future studies

Mission-oriented public policy and the new evaluation culture

In this chapter, our aim is to develop a framework to improve public policy-related evaluation practice for a more adaptive and anticipatory evaluation approach, better in tune with complex interactions and interdependencies that have emerged on our policy agenda today. One of the features of this space for interactions that is public policy is its mission orientation. Such an orientation is accompanied by the evolution of public policy instruments, which in turn necessitate new evaluation approaches. We are convinced that this requires developing a conceptual framework, which can be taken forward to test and further operationalise in situations where similar systemic transformations for policy development are elaborated upon. Based on our work on public-sector leadership, we are proposing a framework for evaluation in a more mission-driven and systems-based perspective. The framework seeks to take better into consideration the diversity of policy interventions at our disposal, ranging from traditional budgetary or legislative instruments to experimentation and piloting. Changes are identified in the very characteristics of the societal problems we are trying to solve, as well as in the nature of policy, both subsequently requiring a more multifaceted scope of evaluation, an emerging practice being towards a more mission-oriented one as well as a more nuanced approach depending on whether one is interested in the multi-organisational performance, policy service delivery or quality of outputs and impacts from policy initiatives and projects. The focus of evaluation in turn ranges from the accountability to evaluation criteria, timescale, motivation, as well as type of intervention used.fi=vertaisarvioitu|en=peerReviewed

Recruitment methods in Alzheimer's disease research: general practice versus population based screening by mail

<p>Abstract</p> <p>Background</p> <p>In Alzheimer's disease (AD) research patients are usually recruited from clinical practice, memory clinics or nursing homes. Lack of standardised inclusion and diagnostic criteria is a major concern in current AD studies. The aim of the study was to explore whether patient characteristics differ between study samples recruited from general practice and from a population based screening by mail within the same geographic areas in rural Northern Norway.</p> <p>Methods</p> <p>An interventional study in nine municipalities with 70000 inhabitants was designed. Patients were recruited from general practice or by population based screening of cognitive function by mail. We sent a questionnaire to 11807 individuals ≥ 65 years of age of whom 3767 responded. Among these, 438 individuals whose answers raised a suspicion of cognitive impairment were invited to an extended cognitive and clinical examination. Descriptive statistics, chi-square, independent sample t-test and analyses of covariance adjusted for possible confounders were used.</p> <p>Results</p> <p>The final study samples included 100 patients recruited by screening and 87 from general practice. Screening through mail recruited younger and more self-reliant male patients with a higher MMSE sum score, whereas older women with more severe cognitive impairment were recruited from general practice. Adjustment for age did not alter the statistically significant differences of cognitive function, self-reliance and gender distribution between patients recruited by screening and from general practice.</p> <p>Conclusions</p> <p>Different recruitment procedures of individuals with cognitive impairment provided study samples with different demographic characteristics. Initial cognitive screening by mail, preceding extended cognitive testing and clinical examination may be a suitable recruitment strategy in studies of early stage AD.</p> <p>Clinical Registration</p> <p>ClinicalTrial.gov Identifier: NCT00443014</p