Kieren J. Egan

Body mass index in midlife and dementia: Systematic review and meta-regression analysis of 589,649 men and women followed in longitudinal studies

We conducted a meta‐analysis of the conflicting epidemiologic evidence on the association between midlife body mass index (BMI) and dementia.

Encouraging Innovation for Assistive Health Technologies in Dementia: Barriers, Enablers and Next Steps to Be Taken

INTRODUCTIONnInnovative Assistive Health Technology (AHT) has the potential to improve the quality of life for people with dementia or their families. Although development is in its preliminary stages, research shows first promising results. Despite such progress, we are still to observe widespread integration of technology into communities. If society is to benefit from innovative AHT to assist people with dementia and their caregivers, we must deepen our understanding of the needs, barriers, and enablers of innovative AHT.nnnMETHODSnIn March 2015, multinational focus groups were undertaken to identify the barriers, enablers, stakeholder actions, and a future perspective for the use of AHT in dementia. This exploratory study was carried out in preparation of the first World Health Organization Ministerial Conference on the Global Action against Dementia.nnnRESULTSnThe focus group study identified that innovative AHT for people with dementia and caregivers is at an early stage of development; however, there is substantial promise across a range of different care needs. Focus group discussions identified internationally relevant barriers and enablers for the development of innovative AHT centring on an improved understanding for needs in dementia.nnnCONCLUSIONnThere are many diverse barriers to the development of innovative AHT but none that appear insurmountable regarding the enablers that were mentioned. There is now an overriding imperative for a systematic, coordinated multistakeholder approach with the needs of people with dementia and their caregivers as the centerpiece.

The role of race and ethnicity in sleep, circadian rhythms and cardiovascular health

In recent years, strong evidence has emerged suggesting that insufficient duration, quality, and/or timing of sleep are associated with cardiovascular disease (CVD), and various mechanisms for this association have been proposed. Such associations may be related to endophenotypic features of the sleep homeostat and the circadian oscillator, or may be state-like effects of the environment. Here, we review recent literature on sleep, circadian rhythms and CVD with a specific emphasis on differences between racial/ethnic groups. We discuss the reported differences, mainly between individuals of European and African descent, in parameters related to sleep (architecture, duration, quality) and circadian rhythms (period length and phase shifting). We further review racial/ethnic differences in cardiovascular disease and its risk factors, and develop the hypothesis that racial/ethnic health disparities may, to a greater or smaller degree, relate to differences in parameters related to sleep and circadian rhythms. When humans left Africa some 100,000 years ago, some genetic differences between different races/ethnicities were acquired. These genetic differences have been proposed as a possible predictor of CVD disparities, but concomitant differences in culture and lifestyle between different groups may equally explain CVD disparities. We discuss the evidence for genetic and environmental causes of these differences in sleep and circadian rhythms, and their usefulness as health intervention targets.

Amerindian (but not African or European) ancestry is significantly associated with diurnal preference within an admixed Brazilian population

ABSTRACT Significant questions remain unanswered regarding the genetic versus environmental contributions to racial/ethnic differences in sleep and circadian rhythms. We addressed this question by investigating the association between diurnal preference, using the morningness–eveningness questionnaire (MEQ), and genetic ancestry within the Baependi Heart Study cohort, a highly admixed Brazilian population based in a rural town. Analysis was performed using measures of ancestry, using the Admixture program, and MEQ from 1,453 individuals. We found an association between the degree of Amerindian (but not European of African) ancestry and morningness, equating to 0.16 units for each additional percent of Amerindian ancestry, after adjustment for age, sex, education, and residential zone. To our knowledge, this is the first published report identifying an association between genetic ancestry and MEQ, and above all, the first one based on ancestral contributions within individuals living in the same community. This previously unknown ancestral dimension of diurnal preference suggests a stratification between racial/ethnic groups in an as yet unknown number of genetic polymorphisms.

Timing and quality of sleep in a rural Brazilian family-based cohort, the Baependi Heart Study

Sleep is modulated by several factors, including sex, age, and chronotype. It has been hypothesised that contemporary urban populations are under pressure towards shorter sleep duration and poorer sleep quality. Baependi is a small town in Brazil that provides a window of opportunity to study the influence of sleep patterns in a highly admixed rural population with a conservative lifestyle. We evaluated sleep characteristics, excessive daytime sleepiness, and chronotype using the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Morningness-Eveningness Questionnaire questionnaires, respectively. The sample consisted of 1,334 subjects from the Baependi Heart study (41.5% male; age: 46.5u2009±u200916.2 y, range: 18–89 years). Average self-reported sleep duration was 07:07u2009±u200901:31 (bedtime 22:32u2009±u200901:27, wake up time: 06:17u2009±u200901:25 hh:min), sleep quality score was 4.9u2009+u20093.2, chronotype was 63.6u2009±u200910.8 and daytime sleepiness was 7.4u2009±u20094.8. Despite a shift towards morningness in the population, chronotype remained associated with reported actual sleep timing. Age and sex modulated the ontogeny of sleep and chronotype, increasing age was associated with earlier sleep time and shorter sleep duration. Women slept longer and later, and reported poorer sleep quality than men (pu2009<u20090.0001). This study provides indirect evidence in support of the hypothesis that sleep timing was earlier prior to full urbanisation.

Online Training and Support Programs Designed to Improve Mental Health and Reduce Burden Among Caregivers of People With Dementia: A Systematic Review

INTRODUCTIONnDementia poses a considerable socioeconomic burden to society. On a global scale, family and other unpaid care predominates. Supporting caregivers is crucial, but scalable interventions are currently lacking. Because a growing number of studies have suggested that online training and support programs hold considerable promise for scaling up, we reviewed existing literature.nnnMETHODSnWe systematically searched 6 databases to identify studies of Internet-based interventions designed to train and support caregivers of people with dementia, and we formally assessed risk of bias. Our prespecified primary outcomes of interest included both mental health and caregiver burden/perceived stress. Our secondary outcomes of interest included knowledge, quality of life of caregivers, quality of care, caregiver response to challenging behaviors, coping, and self-efficacy.nnnRESULTSnEight randomized control trials met our inclusion criteria involving over 900 participants. The content and structure of Internet-based interventions, outcome measures, and duration differed markedly, and selection, performance, and reporting biases were varied and on occasion of concern. Six studies reported outcomes in caregivers mental health outcomes, 3 studies reported burden outcomes. Three studies reported knowledge skills, quality of life and reaction to challenging behaviours, whereas 2 studies reported changes in coping outcomes and self-efficacy. No studies reported outcomes on quality of care.nnnDISCUSSIONnAlthough there is some evidence that Internet-based interventions can improve mental health outcomes for informal caregivers of people with dementia, marked methodological diversity across studies prevented the robust pooling of the results. A concerted and cohesive approach from all stakeholders is now required to help realize the full potential of this emerging field.

Cohort profile : the Baependi Heart Study-a family-based, highly admixed cohort study in a rural Brazilian town

Purpose Cardiovascular disease (CVD) is a major challenge to global health. The same epidemiological transition scenario is replayed as countries develop, but with variations based on environment, culture and ethnic mixture. The Baependi Heart Study was set up in 2005 to develop a longitudinal family-based cohort study that reflects on some of the genetic and lifestyle-related peculiarities of the Brazilian populations, in order to evaluate genetic and environmental influences on CVD risk factor traits. Participants Probands were recruited in Baependi, a small rural town in the state of Minas Gerais, Brazil, following by first-degree and then increasingly more distant relatives. The first follow-up wave took place in 2010, and the second in 2016. At baseline, the study evaluated 1691 individuals across 95 families. Cross-sectional data have been collected for 2239 participants. Findings to date Environmental and lifestyle factors and measures relevant to cardiovascular health have been reported. Having expanded beyond cardiovascular health outcomes, the phenotype datasets now include genetics, biochemistry, anthropometry, mental health, sleep and circadian rhythms. Many of these have yielded heritability estimates, and a shared genetic background of anxiety and depression has recently been published. In spite of universal access to electricity, the population has been found to be strongly shifted towards morningness compared with metropolitan areas. Future plans A new follow-up, marking 10u2005years of the study, is ongoing in 2016, in which data are collected as in 2010 (with the exception of the neuropsychiatric protocol). In addition to this, a novel questionnaire package collecting information about intelligence, personality and spirituality is being planned. The data set on circadian rhythms and sleep will be amended through additional questionnaires, actimetry, home sleep EEG recording and dim light melatonin onset (DLMO) analysis. Finally, the anthropometric measures will be expanded by adding three-dimensional facial photography, voice recording and anatomical brain MRI.

A systematic review and meta-analysis of internet-based interventions for carers of persons with dementia: More trials needed

men; 296women, mean age 73,066,7) were followed up for incidence estimation. After 2 years of follow up, 23 (2,38%) incident cases of dementia all-types were identified: 8 (1,71%) cases in urban area, 37,5% men and 62,5% women, and in 15 (3,00%) cases in rural area, 33,4% men and 66,6% women. Conclusions:These preliminary results point out the fact that dementia is an important public health concern for low and middle-income countries like Congo. Detailed statistical analyses are undergoing, more detailed results on the age and sex-specific incidence will be presented during the conference.

Untangling the relationship between mid-life adiposity and late-life dementia: A systematic review and meta-analysis of longitudinal cohort and record linkage studies

dementia. Compared to thosewithout T1D thosewith T1Dwere 83% more likely to get dementia (Hazard Ratio {HR} 1.83, 95% Confidence Interval {CI} 1.3,2.5) and 61% more likely after adjustment for stroke, PAD and hypertension. When excluding those with T2D from the reference group, the magnitude of T1D on dementia risk was larger (HR1⁄41.93, 95% CI,1.3,2.6; fully adjusted HR 1.73, 95% CI 1.3,2.3). Conclusions:This is the first study of dementia in elderly adults with T1D. Those with T1D were 80% more likely to get dementia than those without T1D. Since management of T1D requires vigilance and constant self-care; cognitive impairment poses a threat to this vulnerable population. Future studies need to identify risk and protective factors for dementia in this group newly entering the aging population.