Tooth Loss Is Associated with Brain White Matter Change and Silent Infarction among Adults without Dementia and Stroke

Periodontal disease is a predictor of stroke and cognitive impairment. The association between the number of lost teeth (an indicator of periodontal disease) and silent infarcts and cerebral white matter changes on brain CT was investigated in community-dwelling adults without dementia or stroke. Dental examination and CT were performed in 438 stroke- and dementia-free subjects older than 50 yr (mean age, 63 ± 7.9 yr), who were recruited for an early health check-up program as part of the Prevention of Stroke and Dementia (PRESENT) project between 2009 and 2010. In unadjusted analyses, the odds ratio (OR) for silent cerebral infarcts and cerebral white matter changes for subjects with 6-10 and > 10 lost teeth was 2.3 (95% CI, 1.38-4.39; P = 0.006) and 4.2 (95% CI, 1.57-5.64; P < 0.001), respectively, as compared to subjects with 0-5 lost teeth. After adjustment for age, education, hypertension, diabetes mellitus, hyperlipidemia, and smoking, the ORs were 1.7 (95% CI, 1.08-3.69; P = 0.12) and 3.9 (95% CI, 1.27-5.02; P < 0.001), respectively. These findings suggest that severe tooth loss may be a predictor of silent cerebral infarcts and cerebral white matter changes in community-dwelling, stroke- and dementia-free adults.     

Associations Between Korean Coronary Heart Disease Risk Score and Cognitive Function in Dementia-Free Korean Older Adults

BackgroundCardiovascular risk is a modifiable factor that can help prevent dementia. Given the dearth of optimal treatment options, managing dementia risk factors is crucial. We examined the association between cardiovascular risk, as measured by the Korean coronary heart disease risk score (KRS), and cognitive function in dementia-free elderly individuals.MethodsWe enrolled 8,600 individuals (average age: 69.74 years; 5,206 women) who underwent a medical evaluation from the National Health Insurance Service. KRS was calculated using age, sex, blood pressure, lipid profile, diabetes, and smoking status. Cognitive function was evaluated using Korean Dementia Screening Questionnaire-Cognition (KDSQ-C). Scores of ≥ 6 indicated a cognitive decline. Logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence interval (CI). Weight, height, stroke history, coronary heart disease history, alcohol consumption, and physical activity engagement were adjusted.ResultsThe lowest, middle, and highest groups, according to the KRS, were 5,923 (68.9%), 2,343 (27.2%), and 334 (3.9%), respectively. The highest KRS group in all participants exhibited a greater risk of cognitive decline than the lowest KRS group (OR, 1.339; 95% CI, 1.034–1.734; P = 0.027). The highest KRS female group aged 71–75 years old exhibited greater cognitive decline than the corresponding lowest KRS group (OR, 1.595; 95% CI, 1.045–2.434; P = 0.031).ConclusionIndividuals with high cardiovascular risk were associated with poorer cognitive function than those with low risk, especially older women. Cardiovascular risk factors should be carefully managed to promote healthy mental aging in dementia-free elderly individuals.     

The Recent Decline in Prevalence of Dementia in Developed Countries: Implications for Prevention in the Republic of Korea

With the rapid aging of the population in Korea, the number of older people with dementia is projected to increase, forecasting an epidemic of dementia. Recent trends in dementia in several western countries, however, depict a gradual decline in prevalence and incidence. This decrease has been attributed to an improvement in education and living environments, engagement in healthy behaviors, and reduction in the prevalence of vascular risk factors. In Korea, however, trends in modifiable risk factors do not favor an optimistic outlook due to the continuous increase in the prevalence of hypertension, diabetes mellitus, and obesity. Given these observations, there is much to be gained through the promotion of healthy lifestyles. Moreover, public health resources need to be directed toward the provision of health promotion and preventive services, control and management of vascular risk factors, and improvement in the standard of living. Nationwide initiatives to develop and implement policies and strategies to protect cognitive health throughout the lifespan should be considered a public health priority.     

认知行为治疗与成人注意缺陷多动障碍:认知模式及情绪症状在治疗中的中介作用

目的:探讨认知行为治疗(CBT)对成人注意缺陷多动障碍(ADHD)患者核心症状的直接影响,以及认知模式和情绪症状改变的中介作用。方法:研究纳入既往随机对照试验入组的98名成人ADHD患者,对结果进行二次分析,选取治疗前(T1)、治疗12周结束后(T2)及48周随访(T3)时的核心症状、认知模式及情绪症状得分,构建链式中介模型。结果:CBT可通过焦虑、抑郁情绪症状得分变化影响T2及T3时核心症状得分,也可依次通过认知模式(自动思维和功能失调得分)变化及情绪症状变化影响T3时核心症状得分。结论:CBT短期主要通过改善情绪进而改善ADHD核心症状,同时长期可依次通过认知模式的中介作用影响情绪变化,进而影响ADHD核心症状。     

The effect of remotely delivered lifestyle interventions on cognition in older adults without dementia: A systematic review and meta-analysis

Up to 40% of dementias may be preventable via risk factor modification. This inference has motivated the development of lifestyle interventions for reducing cognitive decline. Typically delivered to older adults face-to-face, the COVID-19 pandemic has necessitated their adaptation for remote delivery. We systematically reviewed randomized controlled trials of remotely delivered lifestyle interventions (≥4 weeks duration and delivered >50% remotely), for adults aged ≥ 60 without dementia, examining effects on objective cognitive measures. Comparators were active (face-to-face or remote) or passive. Ten studies (n = 2967) comprising multidomain (k = 4), physical activity (k = 3) or psychosocial (k = 3) remote interventions were included. Data were synthesized using robust variance estimation meta-analysis. The pooled estimate comparing the effect of remote interventions versus comparators on cognition was not significant (g=−0.02; 95%CI [−0.14, 0.09]; p = .66); subgroup analyses by type of intervention or comparator also yielded non-significant effects. Most studies had low risk of bias. Current evidence to support remote lifestyle interventions is limited. Included studies were conducted pre-pandemic, and evaluated individual, rather than group interventions. Future studies may exploit the greater digital connectivity of older people since the pandemic. Group formats, more frequently efficacious than individual interventions in face-to-face dementia prevention trials, may be a rational approach for future remote trials.     

Sex steroids to maintain cognitive function in women after the menopause: A meta-analyses of treatment trials

It is still debated whether estrogen treatment after the menopause could result in improved cognitive function in women. This debate is based on many animal and cell culture data showing that estrogens can positively affect the aging brain. Observational data also show a halved risk of dementia in women who took estrogens around the age of menopause. However, large treatment trials have shown negative effects of long-term treatment with estrogens in older women. The present meta-analyses included 36 randomised treatment trials and tested various hypotheses which have been developed to attempt to explain discrepant data. Results indicated that, contrary to expectations, age of women and duration of time elapsed when treatment was initiated since menopause (‘window of opportunity’ hypothesis) did not significantly affect treatment outcome, nor did it matter whether women were symptomatic or not. It was not clear whether bilateral oophorectomy affected the outcome, as this effect was based on only a few studies from the same group and some observational studies show negative effects on cognition in surgical menopausal women treated with hormones for more than 10 years. Duration of treatment overall significantly affected outcome. More negative effects were seen in longer studies, where positive effects were mainly seen in short term studies (<4 months). Treatment with combined estrogens and progestagens also negatively affected the outcome. Whether women with symptoms should be treated for a couple of months or using other (intermittent) modes of treatment and whether this could have long-term positive consequences remains to be investigated.