Journal of Alzheimer's Disease - Volume 96, issue 1

Authors: Datlow, Lindsay Y. | King, Jay | Leventhal, Mark | Wallace, Taylor C.

Article Type: Research Article

Abstract: Background: Pork provides higher levels of several nutrients important for cognitive maintenance in older adults. A pilot clinical study suggests the addition of moderate amounts of pork to a Mediterranean-style diet improves cognition in older adults. There is an absence of observational research that isolates effects of pork from other red meats. Objective: To examine the relationship of pork intake on cognitive performance in older adults. Methods: Cross-sectional data from the U.S. National Health and Nutrition Examination Survey (NHANES) 2011–2014 cycles were used in these analyses. Pork intake was assessed using data from two non-consecutive 24-h …dietary recalls. Cognitive function was assessed by the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) Word Learning, CERAD Delayed Recall, Animal Fluency, and Digital Substitution tests. Statistical analyses were adjusted for sample weighting and survey design variables to account for the complex design. Student t -tests (continuous variables) and Pearson chi-squared tests (categorical variables) were employed to compare participant characteristics between the low and normal cognitive performance groups. Logistic regression was used to determine the relationship of pork intake (low, medium, and high) with prevalence of low cognitive performance, with the non-consumer group as the referent category. Results: Pork intake was not beneficially or detrimentally associated performance on the any of the cognitive tests in both the crude and multivariate models (p  > 0.05). Conclusions: Prospective cohort investigations and larger/longer-term clinical trials are needed to fully elucidate effects of pork intake on cognition in older adults. Show more

Keywords: Alzheimer’s disease, cognition, nutrition surveys, pork meat, red meat

DOI: 10.3233/JAD-230474

Citation: Journal of Alzheimer's Disease, vol. 96, no. 1, pp. 351-358, 2023

Authors: Zhu, Carolyn W. | Gu, Yian | Cosentino, Stephanie | Kociolek, Anton J. | Hernandez, Michelle | Stern, Yaakov

Article Type: Research Article

Abstract: Background: Misidentification of dementia in Medicare claims is quite common. Objective: We examined potential race/ethnic disparities in misidentification of dementia in Medicare claims in a diverse cohort of older adults who underwent careful clinical assessment. Methods: Participants were enrolled in the Washington Heights-Inwood Columbia Aging Project (WHICAP), a multiethnic, population-based, prospective study of cognitive aging in which dementia status was assessed using a rigorous clinical protocol. ICD-9-CM and ICD-10-CM diagnosis codes in all available Medicare claims (1999–2019) were compared to clinical dementia diagnosis and categorized into three mutually exclusive groups: 1) congruent-, 2) over-, and 3) …under- identification during the study period. Multinomial logistic regression model was used to examine the relationship between race (White, African American/Black, other) and ethnicity (Hispanic/Latinx, non-Hispanic/Latinx) and congruency of dementia identification after controlling for clinical (cognition, function, comorbidities) and demographic characteristics (age, sex, education), and inpatient and outpatient utilization. Results: Across all person-years, 88.4% had congruent identification of dementia compared to clinical diagnosis, in 4.1% of the times participants were over-identified with dementia, and 7.5% of the times the participants were under-identified. Rates of misidentification was higher in minority participants than in White, non-Hispanic participants. Multivariable estimation results showed that the probability of over-identification with dementia was 2.2% higher for African American/Black than White (p  = 0.05) and 2.7% higher for Hispanic participants than non-Hispanics (p  = 0.03) participants. Differences in under-identification by race/ethnicity were not statistically significant. Conclusions: African American/Black and Hispanic participants were more likely over-identified with dementia in Medicare claims. Show more

Keywords: Alzheimer’s disease, clinical diagnosis, disparities, Medicare claims

DOI: 10.3233/JAD-230584

Citation: Journal of Alzheimer's Disease, vol. 96, no. 1, pp. 359-368, 2023

Authors: Saji, Naoki | Ishihara, Yuichi | Murotani, Kenta | Uchiyama, Akira | Takeda, Akinori | Sakurai, Takashi | Matsushita, Kenji

Article Type: Research Article

Abstract: Background: Periodontal disease (PeD) is a risk factor of Alzheimer’s disease and is associated with cognitive decline in older adults. However, the relationships between subitems of neuropsychological tests and PeD have not been fully clarified. Objective: To evaluate associations between PeD and subitems of neuropsychological tests. Methods: We performed a cross-sectional analysis of data of 183 participants (women: 50%, mean age: 79 years) from a clinical study. We enrolled patients who visited our memory clinic and assessed demographics, dementia-related risk factors, neuropsychological tests, brain magnetic resonance images, and a dental screening check. We evaluated the relationships …between cognitive function and PeD using multivariable logistic regression analyses. Results: Participants with dementia were less likely to make periodical visits to the dentist, had fewer teeth, had less frequent tooth brushing habits, and were more likely to have PeD. Impaired cognitive function was significantly associated with an increasing degree of PeD. In multivariable logistic regression analyses, impaired visuospatial function and attention were associated with twice the risk of moderate or severe PeD compared with individuals with preserved visuospatial function and attention (odds ratio: 2.11, 95% confidence interval: 1.04–4.29, p  = 0.037). Impaired word recall and recognition and following commands were associated with increased risk of PeD (odds ratio: 2.80, 95% confidence interval: 1.41–5.32, p  = 0.003). Conclusions: Cognitive decline, such as impaired visuospatial function, attention, word recall and recognition, and inability to follow commands were independently and strongly associated with PeD. These items can be assessed easily on a daily basis. Show more

Keywords: Alzheimer’s disease, cognitive decline, dementia, oral health, periodontal disease, periodontitis

DOI: 10.3233/JAD-230742

Citation: Journal of Alzheimer's Disease, vol. 96, no. 1, pp. 369-380, 2023

Authors: Mehta, Kanika | Mohebbi, Mohammadreza | Pasco, Julie A. | Williams, Lana J. | Walder, Ken | Ng, Boon Lung | Gupta, Veer Bala

Article Type: Research Article

Abstract: Background: Poor cognitive function, a major disabling condition of older age, is often considered a prodromal feature of dementia. High mortality and the lack of a cure for dementia have necessitated a focus on the identification of potentially modifiable risk factors. Mental and physical health conditions such as mood disorders and bone loss have been previously linked with poor cognition individually although their combined effect remains largely unknown. Objective: Considering the multifactorial nature of dementia pathology, we investigated whether mood disorders, bone health and their interaction are associated with cognitive function in a population-based sample of men. …Methods: Four hundred and forty-two male participants were drawn from the Geelong Osteoporosis Study. Cognitive function was assessed using the CogState Brief Battery, which measured cognitive performance across four domains and was used to compute overall cognitive function. Mood disorders and hip bone mineral density (BMD) were determined using a semi-structured clinical interview and dual-energy X-ray absorptiometry, respectively. Results: Hip BMD (Bcoeff  = 0.56, 95% CI: [0.07, 1.05], p  = 0.025) but not mood disorder (Bcoeff  = –0.50, 95% CI: [–0.20, 0.10], p  = 0.529) was associated with overall cognitive function after accounting for potential confounders. Interaction effects were observed between the two exposures (Bcoeff  = –1.37, 95% CI: [–2.49, –0.26], p  = 0.016) suggesting that individuals without a mood disorder displayed better cognitive performance with increasing BMD, while those with a lifetime history of mood disorder displayed poorer cognitive function with increasing BMD. Conclusions: These findings highlight the importance of exploring interactions among potentially modifiable health conditions associated with cognitive function. Show more

Keywords: Alzheimer’s disease, bone mineral density, cognitive function, interaction, mood disorder

DOI: 10.3233/JAD-230140

Citation: Journal of Alzheimer's Disease, vol. 96, no. 1, pp. 381-393, 2023

Authors: Ikanga, Jean | Hickle, Sabrina | Schwinne, Megan | Epenge, Emmanuel | Gikelekele, Guy | Kavugho, Immaculee | Tsengele, Nathan | Samuel, Mampunza | Zhao, Liping | Qiu, Deqiang | Stringer, Anthony | Saindane, Amit M. | Alonso, Alvaro | Drane, Daniel L.

Article Type: Research Article

Abstract: Background: Western studies indicate potential associations between hippocampal volume and memory in the trajectory of Alzheimer’s disease (AD). However, limited availability of neuroimaging technology and neuropsychological tests appropriate for sub-Saharan African (SSA) countries makes it difficult to establish neuroanatomical associations of hippocampus and memory in this locale. Objective: This study examined hippocampal volumes and memory in healthy control (HC) and probable AD groups in the Democratic Republic of Congo (DRC). Methods: Forty-six subjects with probable AD and 29 HC subjects were screened using the Community Instrument for Dementia and the Alzheimer Questionnaire. Participants underwent neuroimaging in …Kinshasa, DRC, and memory was evaluated using the African Neuropsychology Battery (ANB). Multiple linear regression was used to determine associations between hippocampal volumes and memory. Results: Patients with probable AD performed significantly worse than HCs on ANB memory measures, and exhibited greater cerebral atrophy, which was significantly pronounced in the medial temporal lobe region (hippocampus, entorhinal cortex). Both AD and HC subjects exhibited high rates of white matter hyperintensities compared to international base rate prevalence, which was significantly worse for probable AD. Both also exhibited elevated rates of microhemorrhages. Regression analysis demonstrated a significant association between hippocampal volume and ANB memory tests. Hippocampal atrophy discriminated probable AD from the HC group. Conclusions: This study establishes the feasibility of conducting neuroimaging research in the SSA, demonstrates many known neuroimaging findings in probable AD patients hold up using culturally appropriate memory tasks, and suggest cardiovascular problems are a greater issue in SSA than in Western countries. Show more

Keywords: African Neuropsychology Battery, Alzheimer’s disease, dementia, hippocampus, magnetic resonance imaging, memory

DOI: 10.3233/JAD-230206

Citation: Journal of Alzheimer's Disease, vol. 96, no. 1, pp. 395-408, 2023

Authors: Pipingas, Andrew | Murphy, Karen J. | Davis, Courtney R. | Itsiopoulos, Catherine | Kingsley, Michael | Scholey, Andrew | Macpherson, Helen | Segal, Leonie | Breckon, Jeff | Minihane, Anne-Marie | Meyer, Denny | Ogden, Edward | Dyer, Kathryn A. | Eversteyn, Emily | Hardman, Roy J. | Poorun, Kaylass | Justice, Keri | Hana, Maher | Buckley, Jonathan D. | White, David | Davison, Kade | Clark, Jessie S. | Bracci, Ella L. | Kennedy, Greg

Article Type: Research Article

Abstract: Background: Several clinical trials have examined diet and physical activity lifestyle changes as mitigation strategies for risk factors linked to cognitive decline and dementias such as Alzheimer’s disease. However, the ability to modify these behaviors longer term, to impact cognitive health has remained elusive. Objective: The MedWalk trial’s primary aim is to investigate whether longer-term adherence to a Mediterranean-style diet and regular walking, delivered through motivational interviewing and cognitive-behavioral therapy (MI-CBT), can reduce age-associated cognitive decline and other dementia risk factors in older, independently living individuals without cognitive impairment. Methods: MedWalk, a one-year cluster-randomized controlled trial …across two Australian states, recruited 60–90-year-old people from independent living retirement villages and the wider community. Participants were assigned to either the MedWalk intervention or a control group (maintaining their usual diet and physical activity). The primary outcome is 12-month change in visual memory and learning assessed from errors on the Paired Associates Learning Task of the Cambridge Neuropsychological Test Automated Battery. Secondary outcomes include cognition, mood, cardiovascular function, biomarkers related to nutrient status and cognitive decline, MI-CBT effectiveness, Mediterranean diet adherence, physical activity, quality of life, cost-effectiveness, and health economic evaluation. Progress and Discussion: Although COVID-19 impacts over two years necessitated a reduced timeline and sample size, MedWalk retains sufficient power to address its aims and hypotheses. Baseline testing has been completed with 157 participants, who will be followed over 12 months. If successful, MedWalk will inform interventions that could substantially reduce dementia incidence and ameliorate cognitive decline in the community. Trial registration: Registered on the Australia New Zealand Clinical Trials Registry ANZCTR 12620000978965 (https://www.anzctr.org.au ). Show more

Keywords: Alzheimer’s disease, cardiovascular, cluster-randomized clinical trial, cognition, cognitive behavioral therapy, dementia, exercise, Mediterranean diet, mood, motivational interviewing, physical activity

DOI: 10.3233/JAD-230641

Citation: Journal of Alzheimer's Disease, vol. 96, no. 1, pp. 409-427, 2023