BACKGROUND: Sex- and age-specific impacts of cardiovascular risk factors on the development of dementia have not been well evaluated. We investigated these impacts of smoking, overweight/obesity, hypertension, and diabetes mellitus on the risk of disabling dementia. METHODS: The study participants were 25,029 (10,134 men and 14,895 women) Japanese aged 40-74 years without disabling dementia at baseline (2008-2013). They were assessed on smoking status (non-current or current), overweight/obesity (body mass index ≥25 kg/m² and ≥30 kg/m², respectively), hypertension (systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg or any antihypertensive medication use), and diabetes mellitus (a fasting serum glucose ≥126 mg/dL, non-fasting glucose ≥200 mg/dL, hemoglobin A1c ≥6.5% by the National Glycohemoglobin Standardization Program or glucose-lowering medication use) at baseline. Disabling dementia was identified as the level of care required ≥1 and cognitive disability grade ≥IIa according to the National Long-term Care Insurance Database. We used a Cox proportional regression model to estimate hazard ratios and 95% confidence intervals (95% CIs) of disabling dementia according to the cardiovascular risk factors and calculated the population attributable fractions (PAFs). RESULTS: During a median follow-up of 9.1 years, 1,322 (606 men and 716 women) developed disabling dementia. Current smoking and hypertension were associated with a higher risk of disabling dementia in both sexes, whereas overweight or obesity was not associated with the risk in either sex. Diabetes mellitus was associated with a higher risk only in women (p for sex interaction = 0.04). The significant PAFs were 13% for smoking and 14% for hypertension in men and 3% for smoking, 12% for hypertension, and 5% for diabetes mellitus in women. The total PAFs of the significant risk factors were 28% in men and 20% in women. When stratified by age, hypertension in midlife (40-64 years) was associated with the increased risk in men, while diabetes mellitus in later-life (65-74 years) was so in women. CONCLUSIONS A substantial burden of disabling dementia was attributable to smoking, and hypertension in both sexes and diabetes mellitus in women, which may require the management of these cardiovascular risk factors to prevent dementia.
Male ; Humans ; Female ; Adult ; Middle Aged ; Overweight/complications* ; East Asian People ; Cardiovascular Diseases/epidemiology* ; Hypertension/etiology* ; Diabetes Mellitus/etiology* ; Obesity/etiology* ; Smoking/epidemiology* ; Risk Factors ; Age Factors ; Dementia/etiology*

OBJECTIVE: To explore incidence, risk factors and the relationship between preoperative heart failure and prognosis in elderly patients with hip fracture. METHODS: A retrospective analysis was performed on 1 569 elderly patients with hip fracture treated from January 2012 to December 2019, including 522 males and 1 047 females, aged 81.00 (75.00, 90.00) years old;896 intertrochanteric fractures and 673 femoral neck fractures. Patients were divided into heart failure and non-heart failure groups according to whether they developed heart failure before surgery, and heart failure was set as the dependent variable, with independent variables including age, gender, fracture type, comorbidities and hematological indicators, etc. Univariate analysis was performed at first, and independent variables with statistical differences were included in multivariate Logistic regression analysis. Independent risk factors for preoperative heart failure were obtained. The length of hospital stay, perioperative complications, mortality at 30 days and 1 year after surgery were compared between heart failure and non-heart failure groups. RESULTS: There were 91 patients in heart failure group, including 40 males and 51 females, aged 82.00 (79.00, 87.00) years old;55 patients with intertrochanteric fracture and 36 patients with femoral neck fracture. There were 1 478 patients in non-heart failure groups, including 482 males and 996 females, aged 81.00(75.00, 86.00) years old;841 patients with intertrochanteric fracture and 637 patients with femoral neck fracture. There were significant differences in age, sex, coronary heart disease, arrhythmia and dementia between two groups(P<0.05). Multivariate Logistic analysis of statistically significant factors showed that males(OR=1.609, P=0.032), age(OR=1.032, P=0.031), arrhythmia(OR=2.045, P=0.006), dementia (OR=2.106, P=0.014) were independent risk factor for preoperative heart failure. The 30-day and 1-year mortality rates were 9.9% and 26.4% in heart failure group and 3.6% and 13.8% in non-heart failure group, respectively;and had statistical significance between two groups (P<0.05). There were significant differences in pulmonary infection, cerebrovascular complications and cardiovascular complications between two groups (P<0.05). The duration of hospitalization in heart failure group was (16.21±10.64) d compared with that in non-heart failure group (13.26±8.00) d, and the difference was statistically significant (t=2.513, P=0.012). CONCLUSION Male, old age, arrhythmia and dementia are independent risk factors for heart failure after hip fracture in elderly patients. Patients with preoperative heart failure have a higher incidence of postoperative pulmonary infection, cerebrovascular and cardiovascular complications, higher mortality at 30 d and 1 year after surgery, and longer hospital stay.
Aged ; Female ; Humans ; Male ; Aged, 80 and over ; Retrospective Studies ; Hip Fractures/surgery* ; Femoral Neck Fractures ; Heart Failure/etiology* ; Prognosis ; Heart Diseases ; Risk Factors ; Postoperative Complications/etiology* ; Dementia ; Arrhythmias, Cardiac

Dementia/etiology* ; Humans ; Risk Factors

OBJECTIVE: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with high morbidity and mortality. There are about 5%-15% of ALS patients combining with frontotemporal lobe degeneration (FTLD) at the same time and 50% of patients combing with cognitive function changes. The analysis of cortical thickness based on MRI is an important imaging method to evaluate brain structure. The aim of the study was to explore the changes of brain structure in ALS patients by cortical thickness analysis, and to explore the correlation between the brain structure and cognitive function. METHODS: In the study, 18 ALS patients treated in Department of Neurology, Peking University Third Hospital and 18 normal controls (age, gender and education level matched) were included. 3D magnetization prepared rapid gradient echo imaging (MPRAGE) sequence MRI was performed and the cortical thickness was analyzed. At the same time, all the ALS patients took neuropsychology assessments, including: mini-mental state examination (MMSE), verbal fluency test (VFT), Stroop color word test (SCWT), prospective memory (PM), emotional picture perception and recognition, and faux pas story test. RESULTS: After cognitive assessment, two ALS patients had cognitive impairment. One was in accordance with ALS-frontotemporal dementia (FTD) diagnosis and the other one was in accordance with ALS cognitive impairment (ALSci) diagnosis. In all the 18 ALS patients and 18 normal controls, the cortical thickness of the left medial orbitofrontal lobe and the medial temporal lobe were significantly reduced (P < 0.05) in ALS group by the vertex-wise comparison. Cortical thickness of the left entorhinal cortex, the left inferior temporal gyrus, the left medial orbitofrontal lobe and the left insular lobe was significantly reduced (P < 0.05) by the region-wise comparison. However, when only concluded the 16 ALS non-cognitive impairment patients, there was no significant difference between the two groups (P>0.05). There were correlations between the scores of prospective memory, emotional picture perception and recognition, faux pas story test and the cortical thickness of their corresponding regions (P < 0.05). CONCLUSION The cortical thickness of ALS patients are correlated with neuropsychological scores which may reflect the changes of cortical structure corresponding to the cognitive assessment, and may provide help for the early diagnosis of cognitive changes in ALS patients.
Humans ; Amyotrophic Lateral Sclerosis/diagnostic imaging* ; Neurodegenerative Diseases ; Frontotemporal Dementia/psychology* ; Neuropsychological Tests ; Cognitive Dysfunction/etiology* ; Magnetic Resonance Imaging/methods*

BACKGROUND: Single subcortical infarction (SSI) is caused by two main etiological subtypes, which are branch atheromatous disease (BAD) and cerebral small vessel disease (CSVD)-related SSI. We applied the Beijing version of the Montreal Cognitive Assessment (MoCA-BJ), the Shape Trail Test (STT), and the Stroop Color and Word Test (SCWT) to investigate the differences in cognitive performance between these two subtypes of SSI. METHODS: Patients with acute SSIs were prospectively enrolled. The differences of MoCA-BJ, STT, and SCWT between the BAD group and CSVD-related SSI group were analyzed. A generalized linear model was used to analyze the associations between SSI patients with different etiological mechanisms and cognitive function. We investigated the correlations between MoCA-BJ, STT, and SCWT using Spearman's correlation analysis and established cut-off scores for Shape Trail Test A (STT-A) and STT-B to identify cognitive impairment in patients with SSI. RESULTS: This study enrolled a total of 106 patients, including 49 and 57 patients with BAD and CSVD-related SSI, respectively. The BAD group performances were worse than those of the CSVD-related SSI group for STT-A (83 [60.5-120.0] vs. 68 [49.0-86.5], P = 0.01), STT-B (204 [151.5-294.5] vs. 153 [126.5-212.5], P = 0.015), and the number of correct answers on Stroop-C (46 [41-49] vs. 49 [45-50], P = 0.035). After adjusting for age, years of education, National Institutes of Health Stroke Scale and lesion location, the performance of SSI patients with different etiological mechanisms still differed significantly for STT-A and STT-B. CONCLUSIONS BAD patients were more likely to perform worse than CSVD-related SSI patients in the domains of language, attention, executive function, and memory. The mechanism of cognitive impairment after BAD remains unclear.
Cerebral Infarction ; Cerebral Small Vessel Diseases ; Cognitive Dysfunction/etiology* ; Executive Function ; Humans ; Mental Status and Dementia Tests

OBJECTIVES: Perioperative neurocognitive disorders (PND) is one of the important factors affecting the recovery of the elderly after surgery, and sleep disorders are also one of the common diseases of the elderly. Previous studies have shown that the quality of postoperative sleep may be factor affecting postoperative cognitive function, but there are few studies on the relationship between preoperative sleep disorders and postoperative cognitive dysfunction. This study aims to explore the relationship between preoperative sleep disorders and postoperative delayed neurocognitive recovery in elderly patients, and provide references for improving the prognosis and quality of life of patients. METHODS: This study was porformed as a prospective cohort study. Elderly patients (age≥65 years old) underwent elective non-cardiac surgery at Xiangya Hospital of Central South University from October 2019 to January 2020 were selected and interviewed 1 day before the operation. The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment Scale (MoCA) were used to assess the patient's baseline cognitive status. Patients with preoperative MMSE scores of less than 24 points were excluded. For patients meeting the criteria of inclusion, Pittsburgh Sleep Quality Index (PSQI) scale was used to evaluate the patients, and the patients were divided into a sleep disorder group and a non-sleep disorder group according to the score. General data of patients were collected and intraoperative data were recorded, such as duration of surgery, anesthetic time, surgical site, intraoperative fluid input, intraoperative blood product input, intraoperative blood loss and drug use. On consecutive 5 days after surgery, Numerical Rating Scale (NRS) was used to evaluate the sleep of the previous night and the pain of the day, which were recorded as sleep NRS score and pain NRS score; Confusion Assessment Method for ICU (CAM-ICU) scale and Confusion Assessment Method (CAM) scale were used to assess the occurrence of delirium. On the 7th day after the operation, the MMSE and MoCA scales were used to evaluate cognitive function of patients. We compared the incidence of postoperative complications, the number of deaths, the number of unplanned ICU patients, the number of unplanned secondary operations, etc between the 2 groups. The baseline and prognosis of the 2 groups of patients were analyzed by univariate and multivariate logistics to analyze their correlation. RESULTS: A total of 105 patients were collected in this study, including 32 patients in the sleep disorder group and 73 patients in the non-sleep disorder group. The general information of the 2 groups, such as age, gender, body mass index, and surgery site, were not statistically significant (all CONCLUSIONS Preoperative sleep disorders can increase the risk of delayed neurocognitive function recovery in elderly patients. Active treatment of preoperative sleep disorders may improve perioperative neurocognitive function in elderly patients.
Aged ; Humans ; Mental Status and Dementia Tests ; Postoperative Complications/epidemiology* ; Prospective Studies ; Quality of Life ; Sleep Quality ; Sleep Wake Disorders/etiology*

PURPOSE: In Korea, most elderly with dementia receive care from family members, yet little research is available on the experience of dementia-related anxiety in middle-aged female caregivers for a family member with dementia. The purpose of this study was to describe the lived experience of dementia-related anxiety in middle-aged female caregivers for family members with dementia. METHODS: A descriptive phenomenological study was conducted. A purposive sampling strategy was used to recruit participants. Twelve middle-aged women (40-59 years, mean age = 51.90 years) who were family caregivers were interviewed from February 2014 to August 2014. Data were collected through semistructured interviews and analyzed using Giorgi's method. RESULTS: The essential structure of the phenomenon was a fear of losing self-identity. The main essence was represented by six components: keenly feeling the effects of aging because of memory deficit, continuous comparison of the family member's behavior with that of the participant's, Finding it painful to see a family member with dementia as he/she does not know how this will end, not knowing the conclusion of the disease process, reducing the risk of dementia, and trying to change one's lifestyle from what it used to be in the past. CONCLUSIONS: The study provides the essential structure of the experience on dementia-related anxiety that caregivers of a family member with dementia have. The findings could help healthcare providers and researchers have better understanding of dementia-related anxiety and give more attention to the caregivers to relieve their anxiety
Adult ; Anxiety/*etiology ; Caregivers/*psychology ; Dementia/*psychology ; Family/*psychology ; Family Relations ; Fear ; Female ; Humans ; Middle Aged ; Self Concept

Following the implementation of a long-term care insurance system for the elderly in Korea, many nursing homes have been established and many more patients than ever before have been living at nursing homes. Despite the fact that this is a high-risk group vulnerable to hip fractures, no study has yet been conducted in Korea on hip fracture incidence rates and prognoses among patients residing at nursing homes. We recently studied 46 cases of hip fracture in nursing homes; more specifically, we investigated the most common conditions under which fractures occur, and examined the degree of recovery of ambulatory ability and the mortality within 1 yr. Among those who had survived after 1 yr, the number of non-functional ambulators increased from 8 hips before hip fracture to 19 hips at final post-fracture follow-up. These individuals showed poor recovery of ambulatory ability, and the number who died within one year was 11 (23.9%), a rate not significantly different from that among community-dwelling individuals. It was evident that hip-joint-fracture nursing home residents survived for similar periods of time as did those dwelling in the community, though under much more uncomfortable conditions. The main highlight of this report is that it is the first from Korea on nursing home residents' ambulatory recovery and one-year mortality after hip fracture. The authors believe that, beginning with the present study, the government should collect and evaluate the number of hips fractured at nursing facilities in order to formulate criteria that will help to enable all patients to select safer and better-quality nursing facilities for themselves or their family members.
Aged ; Aged, 80 and over ; Body Mass Index ; Cerebrovascular Disorders/etiology ; Dementia/etiology ; Female ; Hip Fractures/complications/*epidemiology/mortality ; Humans ; Insurance, Long-Term Care ; Kaplan-Meier Estimate ; Male ; Nursing Homes ; Odds Ratio ; Parkinson Disease/etiology ; Republic of Korea/epidemiology ; Risk Factors

PURPOSE: The objective of this systematic review was to assess the effects of family support programs on caregiving burden, depression, and stress in family caregivers of people with dementia. METHODS: A literature search was conducted of electronic databases to identify randomized controlled studies with family support programs done between 2000 and 2014. Studies published in English and/or Korean were included for the analysis with search strategies adapted from the Cochrane Dementia and Cognitive Improvement Group. Studies were rated for quality assessment by two independent reviewers using the appraisal checklist developed by Cochrane Reviews and Dissemination. Of 8,334 articles identified in the literature search, full texts of 76 articles that met the inclusion criteria were reviewed and 38 were found to include relevant outcomes. RESULTS: Results from selected studies were pooled in statistical meta-analysis using Review Manager Software and heterogeneity between combined studies was assessed using the Chisquare test. Meta-analysis showed that the effect sizes of family caregiver support programs were small to medium for categories of caregiving burden (Hedge's g= - 0.17, 95% CI= - 0.30~ - 0.04), depression (Hedge's g= - 0.30, 95% CI= - 0.40~ - 0.20), and stress (Hedge's g= - 0.39, 95% CI= - 0.52~ - 0.25). CONCLUSION: The review results indicate that a support programs can assist family caregivers in reducing their psycho-emotional distress.
Caregivers/*psychology ; Clinical Trials as Topic ; Databases, Factual ; Dementia/*pathology ; Depression/*etiology ; Humans ; *Program Evaluation ; *Stress, Psychological

The present study was aimed at determining the effects of Tongqiao Huoxue Decoction (TQHXD) on the Ca(2+)-CaMKII-CREB pathway and the memory and learning capacities of rats with vascular dementia (VD). The rat VD model was established by using an improved bilateral carotid artery ligation method. The Morris water maze experiment was used to evaluate the ethology of the VD rats following treatments with TQHXD at 3.01, 6.02, and 12.04 g·kg(-1) per day for 31 days. At the end of experiment, the hippocampus were harvested and analyzed. Western blotting and RT-PCR were used to measure the expression levels of calmodulin-binding protein kinase II(CaMKII), protein kinase A(PKA), cAMP-response element binding protein(CREB), and three N-methyl-D-aspartic acid receptor subunits (NR1, NR2A, and NR2B). Our results revealed that TQHXD could alleviate the loss of learning abilities and increase the memory capacity (P < 0.05 and P < 0.01 vs the model group, respectively). The treatment with 6.02 and 12.04 g·kg(-1) of TQHXD significantly up-regulated the Ca(2+)-CaMKII-CREB pathway in the hippocampus. In conclusion, TQHXD showed therapeutic effects on a bilateral carotid artery ligation-induced vascular dementia model, through the up-regulation of calcium signalling pathways.
Animals ; Calcium ; metabolism ; Calcium-Calmodulin-Dependent Protein Kinase Type 2 ; metabolism ; Cyclic AMP Response Element-Binding Protein ; metabolism ; Dementia, Vascular ; complications ; drug therapy ; metabolism ; psychology ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Female ; Hippocampus ; drug effects ; metabolism ; Learning Disabilities ; drug therapy ; etiology ; metabolism ; Male ; Maze Learning ; drug effects ; Memory ; drug effects ; Memory Disorders ; drug therapy ; etiology ; metabolism ; Phytotherapy ; Rats, Sprague-Dawley ; Signal Transduction ; Up-Regulation