Risk Factors Associated With Alzheimer Disease and Related Dementias by Sex and Race and Ethnicity in the US

Nianogo, Roch A.; Rosenwohl‐Mack, Amy; Yaffe, Kristine; Carrasco, Anna; Hoffmann, Coles M.; Barnes, Deborah E.

doi:10.1001/jamaneurol.2022.0976

Cited by 130 publications

(77 citation statements)

References 33 publications

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“…The relationship of BMI with cognitive function has been reported in numerous studies with inconsistent findings. Some studies found neuroprotective effects for the BMI-defined statuses of overweight and obese in later life [ 14 , 15 , 16 , 17 , 18 , 19 , 20 ], while some research reported detrimental neurological effects caused by BMI-defined obesity [ 6 , 9 , 10 , 11 , 12 ]. We found that a reverse J-shaped relationship of BMI with cognitive impairment was identified in the current research, suggesting that the BMI-defined statuses of overweight and obese could be related to a decreased risk of cognitive impairment and that the BMI-defined status of underweight could be related to an increased risk.…”

Section: Discussionmentioning

confidence: 99%

“…Although the mechanism has not been completely explained, it has been widely proposed that unfavorable weight status may affect metabolic functions, promote inflammation, and disrupt the balance of gut microbiota, which could increase the risk of poor cognitive function [ 5 ]. However, previous epidemiological studies have shown conflicting results between BMI and cognitive function, with some research suggesting that higher BMI contributes to poor cognitive function [ 6 , 7 , 8 , 9 , 10 , 11 , 12 ], and other studies observing an apparent beneficial effect of higher BMI on cognitive function [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. Also, few large, prospective cohort studies have been conducted in the older Chinese population.…”

Section: Introductionmentioning

confidence: 99%

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Association of Body Mass Index and Plant-Based Diet with Cognitive Impairment among Older Chinese Adults: A Prospective, Nationwide Cohort Study

Fang

Turner‐McGrievy

et al. 2022

Nutrients

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To examine the association of body mass index (BMI) and a plant-based diet (PBD) with cognitive impairment in older adults, this cohort study used data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a national, community-based, longitudinal, prospective study in China. Cognitive function was evaluated via the Mini-Mental State Examination (MMSE). Diet was assessed using a simplified food frequency questionnaire (FFQ), and PBD patterns were estimated using the overall plant-based diet index (PDI), the healthful plant-based diet index (hPDI), and the unhealthful plant-based diet index (uPDI). BMI was measured objectively during the physical examination. Cox proportional hazard models and restricted cubic spline analyses were used. A total of 4792 participants with normal cognition at baseline were included, and 1077 participants were identified as having developed cognitive impairment during the 24,156 person-years of follow-up. A reverse J-shaped association was observed between BMI and cognitive impairment (p = 0.005 for nonlinearity). Participants who were overweight (HR = 0.79; 95% CI 0.66–0.95) and obese (HR = 0.72; 95% CI 0.54–0.96) had a decreased risk of cognitive impairment, while those who were underweight (HR = 1.42; 95% CI 1.21–1.66) had an increased risk. Lower PDI, lower hPDI, and higher uPDI were associated with an increased risk of cognitive impairment (HR = 1.32; 95% CI 1.16–1.50 for PDI; HR = 1.46; 95% CI 1.29–1.66 for hPDI; HR = 1.21; 95% CI 1.06–1.38 for uPDI). The protective effect of being overweight on cognitive impairment was more pronounced among participants with a higher PDI (HR = 0.74; 95% CI 0.57–0.95) than those with a lower PDI (HR = 0.87; 95% CI 0.67–1.12), among participants with a higher hPDI (HR = 0.73; 95% CI 0.57–0.94) than those with a lower hPDI (HR = 0.93; 95% CI 0.72–1.10), and among participants with a lower uPDI (HR = 0.61; 95% CI 0.46–0.80) than those with a higher uPDI (HR = 1.01; 95% CI 0.80–1.27). Our results support the positive associations of overweight status, obesity, an overall PBD, and a healthful PBD with cognitive function in older adults. A lower adherence to an overall PBD, a healthful PBD, and a higher adherence to an unhealthful PBD may attenuate the protective effect of being overweight on cognitive function.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association of Body Mass Index and Plant-Based Diet with Cognitive Impairment among Older Chinese Adults: A Prospective, Nationwide Cohort Study

Fang

Turner‐McGrievy

et al. 2022

Nutrients

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“…In addition to generally having more pre-dispositional factors, it is important to note that women also have a higher rate of mortality due to obesity-related complications because they have a higher risk of developing these complications [ 27 ]. Dementia is one such complication, and given that JAMA reports that two-thirds of the adults diagnosed with AD are women, obesity is a pivotal modifiable risk factor [ 5 ].…”

Section: Factors Affecting the Development Of Obesitymentioning

confidence: 99%

“…Current research links the obesity epidemic to multiple detrimental chronic conditions (e.g., diabetes, heart disease, dementia) that have lowered the quality and length of life for countless individuals ( Figure 1 ) [ 3 ]. As of 2020, 55 million people have been diagnosed with dementia and by 2050 this number is expected to rise to 139 million, likely due to the steady rise in obesity prevalence [ 3 , 4 , 5 ]. This article examines the factors surrounding the development of obesity and the role that obesity plays in perpetuating the prevalence of diabetes and dementia.…”

Section: Introductionmentioning

confidence: 99%

“…The rise in the incidence of obesity and diabetes leads to a corresponding increase in the risk of developing dementia. The table above was constructed utilizing data from the Centers for Disease Control and Prevention (CDC) with these parameters: (1) adults aged 20 years and older, (2) obesity prevalence calculated based upon only adults classified as having “obesity,” (3) diabetes mellitus prevalence calculated using data encompassing type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) as well as physician- and non-physician-diagnosed diabetes [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

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The Role of Obesity and Diabetes in Dementia

Burns

Reddy

Culberson

et al. 2022

IJMS

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Chronic conditions such as obesity, diabetes, and dementia are increasing in the United States (US) population. Knowledge of these chronic conditions, preventative measures, and proper management tactics is important and critical to preventing disease. The overlap between obesity, diabetes, and dementia is becoming further elucidated. These conditions share a similar origin through the components of increasing age, gender, genetic and epigenetic predispositions, depression, and a high-fat Western diet (WD) that all contribute to the inflammatory state associated with the development of obesity, diabetes, and dementia. This inflammatory state leads to the dysregulation of food intake and insulin resistance. Obesity is often the cornerstone that leads to the development of diabetes and, subsequently, in the case of type 2 diabetes mellitus (T2DM), progression to “type 3 diabetes mellitus (T3DM).” Obesity and depression are closely associated with diabetes. However, dementia can be avoided with lifestyle modifications, by switching to a plant-based diet (e.g., a Mediterranean diet (MD)), and increasing physical activity. Diet and exercise are not the only treatment options. There are several surgical and pharmacological interventions available for prevention. Current and future research within each of these fields is warranted and offers the chance for new treatment options and a better understanding of the pathogenesis of each condition.

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Association of Early Adulthood Hypertension and Blood Pressure Change With Late-Life Neuroimaging Biomarkers

et al. 2023

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ImportanceThe association between hypertension developed before midlife and late-life brain health is understudied and, because of the cardioprotective benefits of estrogen before menopause, may differ by sex.ObjectiveTo assess the association of early adulthood hypertension and blood pressure (BP) change with late-life neuroimaging biomarkers and examine potential sex differences.Design, Setting, and ParticipantsThis cohort study used data from the Study of Healthy Aging in African Americans (STAR) and Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study, which were harmonized longitudinal cohorts of racially and ethnically diverse adults aged 50 years and older from the San Francisco Bay area and Sacramento Valley in California. The STAR was conducted from November 6, 2017, to November 5, 2021, and the KHANDLE study was conducted from April 27, 2017, to June 15, 2021. The current study included 427 participants from the KHANDLE and STAR studies who received health assessments between June 1, 1964, and March 31, 1985. Regional brain volumes and white matter (WM) integrity were measured via magnetic resonance imaging between June 1, 2017, and March 1, 2022.ExposuresHypertension status (normotension, transition to hypertension, and hypertension) and BP change (last measure minus first measure) were assessed at 2 multiphasic health checkups (MHCs; 1964-1985) in early adulthood (ages 30-40 years).Main Outcomes and MeasuresRegional brain volumes and WM integrity were measured using 3T magnetic resonance imaging and z standardized. General linear models adjusted for potential confounders (demographic characteristics and study [KHANDLE or STAR]) were used to assess the association of hypertension and BP change with neuroimaging biomarkers. Sex interactions were tested.ResultsAmong 427 participants, median (SD) ages were 28.9 (7.3) years at the first MHC, 40.3 (9.4) years at the last MHC, and 74.8 (8.0) years at neuroimaging. A total of 263 participants (61.6%) were female and 231 (54.1%) were Black. Overall, 191 participants (44.7%) had normotension, 68 (15.9%) transitioned to hypertension, and 168 (39.3%) had hypertension. Compared with participants who had normotension, those who had hypertension and those who transitioned to hypertension had smaller cerebral volumes (hypertension: β = −0.26 [95% CI, −0.41 to −0.10]; transition to hypertension: β = −0.23 [95% CI, −0.44 to −0.23]), with similar differences in cerebral gray matter volume (hypertension: β = −0.32 [95% CI, −0.52 to −0.13]; transition to hypertension: β = −0.30 [95% CI, −0.56 to −0.05]), frontal cortex volume (hypertension: β = −0.43 [95% CI, −0.63 to −0.23]; transition to hypertension: β = −0.27 [95% CI, −0.53 to 0]), and parietal cortex volume (hypertension: β = −0.22 [95% CI, −0.42 to −0.02]; transition to hypertension: β = −0.29 [95% CI, −0.56 to −0.02]). Participants with hypertension also had smaller hippocampal volume (β = −0.22; 95% CI, −0.42 to −0.02), greater ventricular volumes (lateral ventricle: β = 0.44 [95% CI, 0.25-0.63]; third ventricle: β = 0.20 [95% CI, 0.01-0.39]), larger free water volume (β = 0.35; 95% CI, 0.18-0.52), and lower fractional anisotropy (β = −0.26; 95% CI, −0.45 to −0.08) than those who had normotension. Holding hypertension status constant, a 5-mm Hg increase in systolic BP was associated with smaller temporal cortex volume (β = −0.03; 95% CI, −0.06 to −0.01), while a 5-mm Hg increase in diastolic BP was associated with smaller parietal cortex volume (β = −0.06; 95% CI, −0.10 to −0.02). The negative association of hypertension and BP change with regional brain volumes appeared stronger in men than women for some regions.Conclusions and RelevanceIn this cohort study, early adulthood hypertension and BP change were associated with late-life volumetric and WM differences implicated in neurodegeneration and dementia. Sex differences were observed for some brain regions whereby hypertension and increasing BP appeared more detrimental for men. These findings suggest that prevention and treatment of hypertension in early adulthood is important for late-life brain health, particularly among men.

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Risk Factors Associated With Alzheimer Disease and Related Dementias by Sex and Race and Ethnicity in the US

Cited by 130 publications

References 33 publications

Association of Body Mass Index and Plant-Based Diet with Cognitive Impairment among Older Chinese Adults: A Prospective, Nationwide Cohort Study

Association of Body Mass Index and Plant-Based Diet with Cognitive Impairment among Older Chinese Adults: A Prospective, Nationwide Cohort Study

The Role of Obesity and Diabetes in Dementia

Association of Early Adulthood Hypertension and Blood Pressure Change With Late-Life Neuroimaging Biomarkers

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