Education, neighborhood environment, and cognitive decline: Findings from two prospective cohort studies of older adults in China

Wang, Yingzhe; Jiang, Yanfeng; Wu, Wanqing; Xu, Kelin; Zhao, Qianhua; Tan, Ziyi; Liang, Xiaoniu; Fan, Min; Xiao, Zhenxu; Lv, Zheng; Ding, Shijin; Dong, Qiang; Hong, Zhen; Jin, Li; Chen, Xingdong; Ding, Ding; Cui, Mei

doi:10.1002/alz.12679

Cited by 10 publications

(8 citation statements)

References 45 publications

(92 reference statements)

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“…We categorized environmental measures into 15 exposure types ( Supplementary Table S2 ). The most common environmental exposures were green space and/or blue space (water) (30%) [ 35 , 41 , 46 – 48 , 51 , 53 , 57 , 60 , 61 , 63 ], neighborhood socioeconomic status (SES) (25%) [ 30 , 31 , 33 , 37 , 42 , 44 , 52 , 54 , 55 , 62 ] and recreation/physical activity facilities (20%) ( Figure 2 ) [ 6 , 25 , 29 , 42 , 49 , 50 , 57 ]. Most studies (65%) only provided environmental exposure measures at one timepoint ( Table 1 ) [ 6 , 25 – 27 , 29 , 31 – 35 , 37 , 38 , 40 – 45 , 53 – 55 , 57 – 59 , 61 , 62 ].…”

Section: Resultsmentioning

confidence: 99%

Systematic Review of Longitudinal Evidence and Methodologies for Research on Neighborhood Characteristics and Brain Health

Michael,

Senerat,

Buxbaum

et al. 2024

Public Health Rev

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Objective: Synthesize longitudinal research evaluating neighborhood environments and cognition to identify methodological approaches, findings, and gaps.Methods: Included studies evaluated associations between neighborhood and cognition longitudinally among adults >45 years (or mean age of 65 years) living in developed nations. We extracted data on sample characteristics, exposures, outcomes, methods, overall findings, and assessment of disparities.Results: Forty studies met our inclusion criteria. Most (65%) measured exposure only once and a majority focused on green space and/or blue space (water), neighborhood socioeconomic status, and recreation/physical activity facilities. Similarly, over half studied incident impairment, cognitive function or decline (70%), with one examining MRI (2.5%) or Alzheimer’s disease (7.5%). While most studies used repeated measures analysis to evaluate changes in the brain health outcome (51%), many studies did not account for any type of correlation within neighborhoods (35%). Less than half evaluated effect modification by race/ethnicity, socioeconomic status, and/or sex/gender. Evidence was mixed and dependent on exposure or outcome assessed.Conclusion: Although longitudinal research evaluating neighborhood and cognitive decline has expanded, gaps remain in types of exposures, outcomes, analytic approaches, and sample diversity.

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Section: Resultsmentioning

confidence: 99%

Systematic Review of Longitudinal Evidence and Methodologies for Research on Neighborhood Characteristics and Brain Health

Michael,

Senerat,

Buxbaum

et al. 2024

Public Health Rev

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“…Nguyen et al ’s systematic review indicated that education has the potential to act as a preventive factor against dementia ( 43 ). A study in China involving 1,286 older adult individuals supports the key role of education in maintaining cognitive health in disadvantageous settings ( 44 ). The UPDRS-III is a test used to assess motor function in patients with PD.…”

Section: Discussionmentioning

confidence: 96%

A nomogram based on neuron-specific enolase and substantia nigra hyperechogenicity for identifying cognitive impairment in Parkinson’s disease

Hou,

Yang,

et al. 2024

Quant Imaging Med Surg

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Background One in four individuals with Parkinson’s disease (PD) experience cognitive impairment (CI). However, few practical models integrating clinical and neuroimaging biomarkers have been developed to address CI in PD. This study aimed to evaluate the correlation between circulating neuron-specific enolase (NSE) levels, substantia nigra hyperechogenicity (SNH), and cognitive function in PD and to develop a nomogram based on clinical and neuroimaging biomarkers for predicting CI in patients with PD. Methods A total of 385 patients with PD who underwent transcranial sonography (TCS) from January 2021 to December 2022 at Beijing Tiantan Hospital, Capital Medical University, were recruited as the training cohort. For validation, 165 patients with PD treated from January 2023 to December 2023 were enrolled. Data for SNH, plasma NSE, and other clinical measures were collected, and cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Logistic regression analysis was employed to select potential risk factors and establish a nomogram. The receiver operating characteristic curve and calibration curve were generated to evaluate the performance of the nomogram. Results Patients with PD exhibiting CI displayed advanced age, elevated Unified PD Rating Scale-III (UPDRS-III) score, an increased percentage of SNH, higher levels of plasma NSE and homocysteine (Hcy), a larger SNH area, and lower education levels compared to PD patients without CI. Gender [odds ratio (OR) =0.561, 95% confidence interval (CI): 0.330–0.954, P=0.03], age (OR =1.039; 95% CI: 1.011–1.066; P=0.005), education level (OR =0.892; 95% CI: 0.842–0.954; P<0.001), UPDRS-III scores (OR =1.026; 95% CI: 1.009–1.043; P=0.003), plasma NSE concentration (OR =1.562; 95% CI: 1.374–1.776; P<0.001), and SNH (OR =0.545; 95% CI: 0.330–0.902; P=0.02) were independent predictors of CI in patients with PD. A nomogram developed using these six factors yielded a moderate discrimination performance with an area under the curve (AUC) of 0.823 (95% CI 0.781–0.864; P<0.001). The calibration curve demonstrated acceptable agreement between predicted outcomes and actual values. Validation further confirmed the reliability of the nomogram, with an AUC of 0.864 (95% CI: 0.805–0.922; P<0.001). Conclusions The level of NSE in plasma and the SNH assessed by TCS are associated with CI in patients with PD. The proposed nomogram has the potential to facilitate the detection of cognitive decline in individuals with PD.

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“…Further subgroup analysis revealed that cognitive decline was significantly correlated with an increase in peripheral IL‐6 but not with CRP or TNF‐α levels. In addition, the incidence of cognitive decline in articles published before 2014 was significantly higher, which may be related to fewer social activities, 44 a low level of education, 45 and a disadvantaged neighborhood environment 46 …”

Section: Discussionmentioning

confidence: 99%

“…In addition, the incidence of cognitive decline in articles published before 2014 was significantly higher, which may be related to fewer social activities, 44 a low level of education, 45 and a disadvantaged neighborhood environment. 46 The effect of CRP on cognitive function has been controversial. It has been known to directly damage cerebral brain microvascular endothelial cells (ECs) 47 and further increase the permeability of the blood-brain barrier (BBB), thus activating neuroinflammation and resulting in cognitive impairment.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of cognitive decline in older individuals without dementia: An updated meta‐analysis

Feng

Wang

Zeng

et al. 2023

Ann Clin Transl Neurol

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Objective: To evaluate the effect of overall peripheral inflammatory levels on cognitive function, we explored the relationship between established biomarkers of peripheral inflammation (circulating C-reactive protein [CRP], interleukin-6 [IL-6], and tumor necrosis factor-a [TNF-a]) and cognitive decline by performing a review of observational studies and creating an updated summary. Methods: We included literatures exploring the relationship between peripheral levels of CRP, IL-6, and TNF-a and subsequent cognitive decline, published until July 2022, by searching the following databases: PubMed, Embase, Web of Science, the Cochrane Library, ClinicalTrials, CNKI, and VIP databases. We used random-effects models to pool the odds ratios (ORs) for the risks of subsequent cognitive decline in older adults with high levels of peripheral inflammation. We initially screened out 501 literatures, of which only 17 were ultimately eligible. Overall, there were 19,516 older individuals included in our meta-analysis, and 2134 of them experienced subsequent cognitive change. Results: Individuals with high levels of peripheral inflammation may have 14% more chance to develop subsequent cognitive decline than those with low levels (OR = 1.14, 95% CI: 1.03-1.27; p < 0.00001). In the subgroup analysis, the incidence of cognitive decline was higher in individuals with high levels of IL-6. This study further demonstrates the link between systemic inflammation and cognitive status. Interpretation: Detecting CRP, IL-6, and TNF-a in peripheral blood is necessary, as they may become effective indicators for forthcoming cognitive performance.

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Education, neighborhood environment, and cognitive decline: Findings from two prospective cohort studies of older adults in China

Cited by 10 publications

References 45 publications

Systematic Review of Longitudinal Evidence and Methodologies for Research on Neighborhood Characteristics and Brain Health

Systematic Review of Longitudinal Evidence and Methodologies for Research on Neighborhood Characteristics and Brain Health

A nomogram based on neuron-specific enolase and substantia nigra hyperechogenicity for identifying cognitive impairment in Parkinson’s disease

Predictors of cognitive decline in older individuals without dementia: An updated meta‐analysis

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