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Neurology Oct 2022Leisure activities are major components of modifiable and healthy lifestyles and are proposed to help prevent the development of dementia. This study aimed to assess the... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND OBJECTIVES
Leisure activities are major components of modifiable and healthy lifestyles and are proposed to help prevent the development of dementia. This study aimed to assess the effects of different types of leisure activities, including cognitive, physical, and social activities, on the incidence of all-cause dementia (ACD), Alzheimer disease (AD), and vascular dementia (VD).
METHODS
We performed a systematic review and meta-analysis of the Cochrane, PubMed, Embase, and Web of Science databases to identify longitudinal studies that examined associations between leisure activities and dementia. Relative risks (RRs) and 95% CIs were pooled using random-effects meta-analysis. Subgroup analyses were used to estimate potential effect modifiers. The study was registered with PROSPERO (CRD42019116857).
RESULTS
A total of 38 longitudinal studies, with 2,154,818 participants at baseline, 74,700 ACD cases, 2,848 AD cases, and 1,423 VD cases during follow-up, were included in the meta-analysis. The subgroup analyses showed that physical (RR 0.83, 95% CI 0.78-0.88), cognitive (RR 0.77; 95% CI 0.68-0.87), and social (RR 0.93; 95% CI 0.87-0.99) activities were associated with a decreased incidence of ACD. In addition, physical (RR 0.87; 95% CI 0.78-0.96) and cognitive (RR 0.66; 95% CI 0.52-0.85) activities were related to a reduced risk of AD. Physical activity (RR 0.67; 95% CI 0.53-0.85) was associated with a lower incidence of VD.
DISCUSSION
Our findings suggest that leisure activities are inversely associated with a risk of ACD, AD, and VD.
Topics: Humans; Dementia; Risk Factors; Alzheimer Disease; Dementia, Vascular; Leisure Activities
PubMed: 35948447
DOI: 10.1212/WNL.0000000000200929 -
Ageing Research Reviews Jan 2022Animal models have indicated that influenza vaccination may prevent or delay the onset of dementia. However, the epidemiological evidence in human beings is still... (Meta-Analysis)
Meta-Analysis Review
Animal models have indicated that influenza vaccination may prevent or delay the onset of dementia. However, the epidemiological evidence in human beings is still limited. Given this background, this systematic review and meta-analysis aimed to summarize the current state of the art of observational studies investigating the association between influenza vaccination and the risk of dementia. We searched Scopus and Pubmed/Medline until 24 September 2021 for studies investigating the risk of dementia by influenza vaccination status. After adjustment for potentially important confounding variables, data were reported as risk ratios (RRs) with 95% confidence intervals (CIs). Among 273 articles initially evaluated, five were included for a total of 292,157 older people free from dementia at baseline (mean age=75.5 ± 7.4 years; 46.8% females). All studies were of high quality. Over a mean follow-up of 9 years, influenza vaccination mitigated the risk of dementia (RR=0.97; 95%CI: 0.94-1.00; I =99%). This association held after adjustment for a mean of nine potential confounders (RR=0.71; 95%CI: 0.60-0.94; I =95.9%). In sensitivity analysis, removing one study from the adjusted analyses, the adjusted RR remained similar (RR= 0.67; 95%CI: 0.63-0.70), but the heterogeneity disappears (I =0%). In conclusion, influenza vaccination was associated with a significantly lower risk of dementia suggesting that the vaccination of older people against influenza may also aid in the prevention of dementia.
Topics: Aged; Aged, 80 and over; Dementia; Female; Humans; Influenza, Human; Male; Observational Studies as Topic; Vaccination
PubMed: 34861456
DOI: 10.1016/j.arr.2021.101534 -
International Journal of Geriatric... Aug 2023Dementia Care Navigators (DCNs) are professionals without clinical training, who provide individualised emotional and practical support to people living with dementia,... (Review)
Review
BACKGROUND
Dementia Care Navigators (DCNs) are professionals without clinical training, who provide individualised emotional and practical support to people living with dementia, working alongside clinical services. Navigator services have been implemented but the service offered vary without a consistent overview provided. The aim of this narrative systematic review was to describe and compare existing service formats, and to synthesise evidence regarding their implementation and impacts.
METHODS
The review was registered on PROSPERO [CRD42021292518]. Three electronic databases were searched and included studies reported on a DCN service, defined as a service in which non-clinically trained workers provide personalised advice and support to people with dementia and/or carers in the community. Two independent reviewers screened abstracts and titles and read through full papers for inclusion. Risk of bias was assessed using the Standard Quality Assessment QualSyst.
RESULTS
We included 14 papers reporting on six studies. All services were US-based and only varied by integration and training provided. Studies reported different degrees of impact on service utilisation and on symptoms and mental well-being of people with dementia and their carers, with too little evidence to draw substantial/meaningful conclusions and studies employing different outcome measures. One study evidenced greater impacts on people with more advanced dementia compared to earlier stages.
CONCLUSIONS
DCN services have the potential to effectively provide non-clinical support to people with dementia and carers from the point of diagnosis. Further research from countries other than the USA, focusing on the impact on social care and social support service access and utilisation, and utilising similar established outcome measures are required.
Topics: Humans; Prevalence; Mental Health; Caregivers; Social Support; Dementia
PubMed: 37526320
DOI: 10.1002/gps.5977 -
Neurologia 2024Risk factors for dementia include genetic factors, aging, environmental factors, certain diseases, and unhealthy lifestyle; most types of dementia share a common chronic... (Review)
Review
INTRODUCTION
Risk factors for dementia include genetic factors, aging, environmental factors, certain diseases, and unhealthy lifestyle; most types of dementia share a common chronic systemic inflammatory phenotype. Psoriasis is also considered to be a chronic systemic inflammatory disease. It has been suggested that psoriasis may also contribute to the risk of dementia. The aim of this study was to systematically review the literature on the association between psoriasis and dementia.
DEVELOPMENT
Articles were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the PubMed and Web of Science databases to identify articles published in peer-reviewed journals and studying the association between psoriasis and dementia. Studies meeting the inclusion criteria were reviewed. We used the Newcastle-Ottawa Scale to assess the quality of each study. After applying the inclusion and exclusion criteria, we included 8 studies for review, 3 of which were found to present a higher risk of bias. Six of the 8 studies supported the hypothesis that prior diagnosis of psoriasis increases the risk of dementia; one study including only a few cases reported that psoriasis decreased the risk of dementia, and one study including relatively young patients found no significant association between psoriasis and the risk of dementia.
CONCLUSION
Most studies included in this review supported the hypothesis that psoriasis constitutes a risk factor for dementia. However, well-designed stratified cohort studies assessing both psoriasis severity and treatment status are still required to determine the real effect of psoriasis on the risk of dementia and its subtypes.
Topics: Humans; Chronic Disease; Psoriasis; Risk Factors; Dementia
PubMed: 38161072
DOI: 10.1016/j.nrleng.2023.12.005 -
Public Health Oct 2023Although shift work has been reported as having a link to dementia, evidence remains inconsistent, and a comprehensive dose-response meta-analysis of the association is... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Although shift work has been reported as having a link to dementia, evidence remains inconsistent, and a comprehensive dose-response meta-analysis of the association is still lacking. We therefore conducted this meta-analysis to explore the association between shift work and the risk of dementia.
STUDY DESIGN
Systematic review and dose-response meta-analysis.
METHODS
PubMed, Embase, and Web of Science databases were systematically searched. Fixed or random-effects models were used to estimate the summary relative risks (RRs) and 95% confidence intervals (95% CIs). Generalized least squares regression was used to estimate dose-response associations, and restricted cubic splines were used to examine possible linear or non-linear associations.
RESULTS
Five articles (10 studies) with 72,999 participants and 23,067 cases were eventually included in the meta-analysis. The summary RRs and 95% CIs of dementia risk with shift work and night shift work versus daytime work were 1.13 (95% CI: 1.05-1.21, I = 46.70%) and 1.13 (95% CI: 1.03-1.24, I = 9.20%), respectively. The risk of dementia increased by 1% (RR = 1.01, 95% CI: 1.01-1.02, I = 41.3%) with each 1-year increase in the duration of shift work. We found a non-linear dose-response association between the duration of shift work and the risk of dementia (P = 0.006). Though the shape of the curve was steeper with the duration of shift work <7 years, the increase was more gradual after 7 years.
CONCLUSION
Our findings suggest that shift work may be a risk factor for future dementia and that controlling the length of shift work is a feasible measure that may contribute to prevent dementia.
Topics: Humans; Shift Work Schedule; Risk Factors; Dementia
PubMed: 37625271
DOI: 10.1016/j.puhe.2023.07.029 -
The Journal of Pain May 2023Approximately 50% of persons living with dementia experience pain, yet it is frequently undetected and inadequately managed resulting in adverse consequences. This... (Review)
Review
Approximately 50% of persons living with dementia experience pain, yet it is frequently undetected and inadequately managed resulting in adverse consequences. This review aims to synthesize evidence on the barriers and facilitators of pain management in persons living with dementia. PubMed, CINAHL, PsycINFO, and Web of Science datasets were used for article searching. Inclusion criteria were peer-reviewed original articles written in English that examined the barriers and facilitators of pain management for persons living with dementia. The Mixed Methods Appraisal Tool was used to evaluate the quality of the studies. A total of 26 studies were selected, including 18 qualitative and 3 quantitative (all high quality), as well as 5 mixed methods studies (low-to-high quality). Results were categorized into intrapersonal, interpersonal, environmental, and policy categories. Factors that impact pain management in dementia include cognitive and functional impairment, healthcare workers' knowledge, collaboration and communication, healthcare workers' understanding of patients' baseline behaviors, observation of behaviors, pain assessment tool use, pain management consistency, staffing level, pain guideline/policy, and training. Overall, pain management is challenging in persons living with dementia. The results indicate that there is a need for multi-component interventions that involves multidisciplinary teams to improve pain management in persons living with dementia at the intrapersonal, interpersonal, environmental, and policy levels. PERSPECTIVE: This review systematically synthesized barriers and facilitators of providing pain management in persons living with dementia. Results were presented in intrapersonal, interpersonal, environmental, and policy categories and suggests that multicomponent interventions involving multidisciplinary teams are needed to systematically improve pain management in persons living with dementia.
Topics: Humans; Pain Management; Health Personnel; Pain; Dementia
PubMed: 36634886
DOI: 10.1016/j.jpain.2022.12.014 -
British Journal of Clinical Pharmacology Feb 2023Previous studies on the association between proton pump inhibitor (PPI) intake and the increased risk of dementia has shown discrepancies in their conclusions. We aimed... (Meta-Analysis)
Meta-Analysis Review
AIM
Previous studies on the association between proton pump inhibitor (PPI) intake and the increased risk of dementia has shown discrepancies in their conclusions. We aimed to provide updated evidence based on extensive bias assessments and quantitative sensitivity analyses.
METHODS
We searched the databases PubMed, EMBASE, SCOPUS, CENTRAL and clinicaltrials.gov for prospective studies that examined an association between PPI use and dementia, up to February 2022. Each study was assessed using the Cochrane risk of bias assessment tools for non-randomized studies of interventions (ROBINS-I) or randomized trials (RoB2). Pooled risk ratios (RRs) and 95% prediction intervals were computed using random-effects models. Sensitivity analyses were adjusted for small-study bias.
RESULTS
We included nine observational studies with 204 108 dementia cases in the primary analysis on the association between PPI use vs. non-use and dementia, and the RR was 1.16 (95% CI = 1.00; 1.35). After adjusting for small-study bias by Copas selection model and Rücker's shrinkage procedure, the RR was 1.16 (1.02; 1.32) and 1.15 (1.13; 1.17), respectively. A subgroup analysis of PPI use vs. non-use regarding Alzheimer's disease risk yielded an RR of 1.15 (0.89; 1.50). The secondary analysis on the risk of dementia by use of PPI vs. histamine-2 receptor antagonist showed an RR of 1.03 (0.66; 1.62).
CONCLUSION
This meta-analysis provided no clear evidence for an association between PPI intake and the risk of dementia. Due to discrepancies in sensitivity analyses, however, some risk of dementia by PPI use cannot be ruled out. Since an unequivocal conclusion is still pending, further research is warranted.
Topics: Humans; Proton Pump Inhibitors; Prospective Studies; Bias; Histamine H2 Antagonists; Dementia
PubMed: 36331350
DOI: 10.1111/bcp.15583 -
Ageing Research Reviews Aug 2023The associations between lipocalin-2 (LCN2) with mild cognitive impairment (MCI) and dementia have gained growing interest. However, population-based studies have... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The associations between lipocalin-2 (LCN2) with mild cognitive impairment (MCI) and dementia have gained growing interest. However, population-based studies have yielded inconsistent findings. Therefore, we conducted this essential systematic review and meta-analysis to analyze and summarize the existing population-based evidence.
METHODS
PubMed, EMBASE, and Web of Science were systematically searched until Mar 18, 2022. Meta-analysis was performed to generate the standard mean difference (SMD) of peripheral blood and cerebrospinal fluid (CSF) LCN2. A qualitative review was performed to summarize the evidence from postmortem brain tissue studies.
RESULTS
In peripheral blood, the overall pooled results showed no significant difference in LCN2 across Alzheimer's disease (AD), MCI and control groups. Further subgroup analysis revealed higher serum LCN2 levels in AD compared to controls (SMD =1.28 [0.44;2.13], p = 0.003), while the difference remained insignificant in plasma (SMD =0.04 [-0.82;0.90], p = 0.931). Besides, peripheral blood LCN2 were higher in AD when age difference between AD and controls ≥ 4 years (SMD =1.21 [0.37;2.06], p = 0.005). In CSF, no differences were found in LCN2 across groups of AD, MCI and controls. However, CSF LCN2 was higher in vascular dementia (VaD) compared to controls (SMD =1.02 [0.17;1.87], p = 0.018), as well as compared to AD (SMD =1.19 [0.58;1.80], p < 0.001). Qualitative analysis supported that LCN2 was increased in the brain tissue of AD-related areas, especially in astrocytes and microglia; while LCN2 increased in infarct-related brain areas and over-expressed in astrocytes and macrophages in mixed dementia (MD).
CONCLUSION
The difference in peripheral blood LCN2 between AD and controls may be affected by the type of biofluid and age. No differences were found in CSF LCN2 across AD, MCI and controls groups. In contrast, CSF LCN2 was elevated in VaD patients. Moreover, LCN2 was increased in AD-related brain areas and cells in AD, while in infarcts-related brain areas and cells in MD.
Topics: Humans; Alzheimer Disease; Biomarkers; Cognitive Dysfunction; Dementia, Vascular; Lipocalin-2; Mixed Dementias
PubMed: 37330019
DOI: 10.1016/j.arr.2023.101984 -
Neuroscience and Biobehavioral Reviews May 2020The aim of this meta-analysis is to evaluate the association of fibrinogen with risk of dementia and its subtypes. (Meta-Analysis)
Meta-Analysis
BACKGROUND
The aim of this meta-analysis is to evaluate the association of fibrinogen with risk of dementia and its subtypes.
METHODS
Embase, Pubmed and Web of Science were retrieved systematically up to February 2019. Standard mean difference (SMD) with 95 % confidence intervals was estimated using random-effects models.
RESULTS
Sixteen studies involving 3,649 participants were summarized. Patients with all-cause dementia exhibited higher fibrinogen levels than those in non-dementia controls (SMD = 0.90 [0.43;1.36] p < 0.01). Further subgroup analysis revealed a positive association of fibrinogen with vascular dementia (VaD) (SMD = 1.11 [0.45;1.78] p < 0.01) rather than Alzheimer's disease (AD) (SMD = 0.01 [-0.17;0.19]) p = 0.92) and Parkinson's disease dementia (PDD) (SMD = 0.35 [-0.23;0.93] p = 0.24). This correlation was significant in Europeans (SMD = 0.92 [0.34;1.49] p < 0.01), but probably not in Asian based populations (SMD = 1.04 [-0.09;2.17] p = 0.07), and gradually declined with advancing age (60 ≤ age < 70: SMD = 1.22 [0.38;2.06] p < 0.01; 70 ≤ age < 80: SMD = 0.29 [0.04;0.53] p = 0.02; age ≥ 80: SMD = 0.01 [-0.12;0.15] p = 0.84).
CONCLUSIONS
Plasma fibrinogen is a potential risk factor for all-cause dementia and VaD under the age of 80, and is more obvious in cohorts with people of European descent.
Topics: Dementia; Fibrinogen; Humans; Risk Factors
PubMed: 32081688
DOI: 10.1016/j.neubiorev.2020.02.022 -
Aging & Mental Health Feb 2023Lewy body dementia (LBD) is the second most common neurodegenerative dementia, and it causes earlier mortality and more morbidity than Alzheimer's disease. Reviewing...
OBJECTIVE
Lewy body dementia (LBD) is the second most common neurodegenerative dementia, and it causes earlier mortality and more morbidity than Alzheimer's disease. Reviewing current evidence on its pharmacological management is essential for developing evidence-based clinical guidelines, and for improving the quality of its clinical care. Hence, we systematically reviewed all studies that investigated the efficacy of any medication for managing various symptoms of LBD.
METHOD
We identified eligible studies by searching 15 databases comprehensively. We completed quality assessment, extracted relevant data, and performed GRADE assessment of available evidence. We conducted meta-analyses when appropriate (PROSPERO:CRD42020182166).
RESULTS
We screened 18,884 papers and included 135 studies. Our meta-analyses confirmed level-1 evidence for Donepezil's efficacy of managing cognitive symptoms of dementia with Lewy bodies (DLB) (SMD=0.63; <0.001) and Parkinson's Disease Dementia (PDD) (SMD=0.43; <0.01), and managing hallucinations in DLB (SMD=-0.52; =0.02). Rivastigmine and Memantine have level-2 evidence for managing cognitive and neuropsychiatric symptoms of DLB. Olanzapine and Yokukansan have similar evidence for managing DLB neuropsychiatric symptoms. Level-2 evidence support the efficacy of Rivastigmine and Galantamine for managing cognitive and neuropsychiatric symptoms of PDD.
CONCLUSION
We list evidence-based recommendations for the pharmacological management of DLB and PDD, and propose specific clinical guidelines for improving their clinical management.
UNLABELLED
Supplemental data for this article can be accessed online at https://doi.org/10.1080/13607863.2022.2032601 .
Topics: Humans; Lewy Body Disease; Dementia; Parkinson Disease; Rivastigmine; Alzheimer Disease
PubMed: 35109724
DOI: 10.1080/13607863.2022.2032601