Sarang Kim

Dementia risk estimates associated with measures of depression: a systematic review and meta-analysis

Objectives To perform a systematic review of reported HRs of all cause dementia, Alzheimers disease (AD) and vascular dementia (VaD) for late-life depression and depressive symptomatology on specific screening instruments at specific thresholds. Design Meta-analysis with meta-regression. Setting and participants PubMed, PsycInfo, and Cochrane databases were searched through 28 February 2014. Articles reporting HRs for incident all-cause dementia, AD and VaD based on published clinical criteria using validated measures of clinical depression or symptomatology from prospective studies of general population of adults were selected by consensus among multiple reviewers. Studies that did not use clinical dementia diagnoses or validated instruments for the assessment of depression were excluded. Data were extracted by two reviewers and reviewed by two other independent reviewers. The most specific analyses possible using continuous symptomatology ratings and categorical measures of clinical depression focusing on single instruments with defined reported cut-offs were conducted. Primary outcome measures HRs for all-cause dementia, AD, and VaD were computed where possible for continuous depression scores, or for major depression assessed with single or comparable validated instruments. Results Searches yielded 121 301 articles, of which 36 (0.03%) were eligible. Included studies provided a combined sample size of 66 532 individuals including 6593 cases of dementia, 2797 cases of AD and 585 cases of VaD. The increased risk associated with depression did not significantly differ by type of dementia and ranged from 83% to 104% for diagnostic thresholds consistent with major depression. Risk associated with continuous depression symptomatology measures were consistent with those for clinical thresholds. Conclusions Late-life depression is consistently and similarly associated with a twofold increased risk of dementia. The precise risk estimates produced in this study for specific instruments at specified thresholds will assist evidence-based medicine and inform policy on this important population health issue.

Gender differences in alcohol consumption among middle‐aged and older adults in Australia, the United States and Korea

Objectives: To compare gender differences in alcohol use and the socioeconomic correlates of at‐risk drinking among middle‐aged and older adults in Australia, the United States (US) and South Korea.

Cross-national insights into the relationship between wealth and wellbeing: a comparison between Australia, the United States of America and South Korea

ABSTRACT The positive relationship between wealth and wellbeing has received considerable attention over the last three decades. However, little is known about how the significance of wealth for the health and wellbeing of older adults may vary across societies. Furthermore, researchers tend to focus mainly on income rather than other aspects of financial resources even though older adults often rely on fixed income, particularly after retirement. Using data from the Household, Income and Labour Dynamics in Australia (HILDA) survey (N=1,431), the Health and Retirement Study (HRS) in the United States of America (USA; N=4,687), and the Korean Longitudinal Study of Ageing (KLoSA; N=5,447), this exploratory cross-national study examined the relationship between wealth satisfaction and objective wealth and wellbeing (measured as self-rated health and life satisfaction) among older Australians, Americans and Koreans (50+ years). Regression analyses showed that wealth satisfaction was associated with wellbeing over and above monetary wealth in all three countries. The relationship between monetary wealth and self-rated health was larger for the US than Australian and Korean samples, while the additional contribution of wealth satisfaction to life satisfaction was larger for the Korean than the Australian and US samples. These findings are discussed in terms of the cultural and economic differences between these countries, particularly as they affect older persons.

Body brain life: A randomized controlled trial of an online dementia risk reduction intervention in middle-aged adults at risk of Alzheimer's disease

To examine the efficacy of body brain life (BBL), a 12‐week online dementia risk reduction intervention.

Development of the Motivation to Change Lifestyle and Health Behaviours for Dementia Risk Reduction Scale

Background and Aims: It is not yet understood how attitudes concerning dementia risk may affect motivation to change health behaviours and lifestyle. This study was designed to develop a reliable and valid theory-based measure to understand beliefs underpinning the lifestyle and health behavioural changes needed for dementia risk reduction. Methods: 617 participants aged ≥50 years completed a theory-based questionnaire, namely, the Motivation to Change Lifestyle and Health Behaviours for Dementia Risk Reduction (MCLHB-DRR) scale. The MCLHB-DRR consists of 53 items, reflecting seven subscales of the Health Belief Model. Results: Confirmatory factor analysis was performed and revealed that a seven-factor solution with 27 items fitted the data (comparative fit index = 0.920, root-mean-square error of approximation = 0.047) better than the original 53 items. Internal reliability (α = 0.608-0.864) and test-retest reliability (α = 0.552-0.776) were moderate to high. Measurement of invariance across gender and age was also demonstrated. Conclusions: These results propose that the MCLHB-DRR is a useful tool in assessing the beliefs and attitudes of males and females aged ≥50 years towards dementia risk reduction. This measure can be used in the development and evaluation of interventions aimed at dementia prevention.

Assessing reliability of short and tick box forms of the ANU-ADRI: Convenient alternatives of a self-report Alzheimer's disease risk assessment

To assess the reliability of short versions of the Australian National University Alzheimers Disease Risk Index (ANU‐ADRI).

Protocol for a pragmatic randomised controlled trial of Body Brain Life-General Practice and a Lifestyle Modification Programme to decrease dementia risk exposure in a primary care setting

Introduction It has been estimated that a 10%–25% reduction in seven key risk factors could potentially prevent 1.1–3.0 million Alzheimer’s disease cases globally. In addition, as dementia is preceded by more subtle cognitive deficits which have substantial social and economic impact, effective preventative interventions would likely have more extensive benefits. The current study evaluates in primary care a multidomain risk-reduction intervention targeting adults with high risk of developing dementia. Methods and analysis A randomised controlled trial (RCT) is being conducted to evaluate three intervention programmes using a pragmatic approach suitable to the clinic: (1) a 12-week online and face-to-face dementia risk-reduction intervention (Body Brain Life—General Practice (BBL-GP)); (2) a 6-week face-to-face group lifestyle modification programme (LMP); and (3) a 12-week email-only programme providing general health information. We aim to recruit 240 participants, aged 18 and over, to undergo a comprehensive cognitive and physical assessment at baseline and follow-ups (postintervention, 18, 36 and 62 weeks). The primary outcome is dementia risk measured with the modified version of the Australian National University—Alzheimer’s Disease Risk Index Short Form. Secondary outcomes are cognitive function measured with Trails A and B, and the Digit Symbol Modalities Test; physical activity with moderate-vigorous physical activity and the International Physical Activity Questionnaire; depression with the Centre for Epidemiological Studies Depression; cost evaluation with the 12-item Short Form Health Survey, Framingham Coronary Heart Disease Risk Score and Australian Type 2 Diabetes Risk Assessment Tool; diet quality with the Australian Recommended Food Score; and sleep quality with the Pittsburgh Sleep Quality Index. Ethics and dissemination This RCT is a novel pragmatic intervention applied in a primary care setting to reduce the dementia risk exposure in adults at high risk. If successful, BBL-GP and LMP will provide a versatile, evidence-based package that can be easily and quickly rolled out to other primary care settings and which can be scaled up at relatively low cost compared with other strategies involving intensive interventions. Trial registration number ACTRN12616000868482

WHAT DOES THE GENERAL PUBLIC REALLY WANT TO KNOW ABOUT DEMENTIA? A FOCUS GROUP STUDY

Background:Dementia is a highly stigmatized condition. The two main stigma reduction strategies that have been successfully applied to other stigmatized conditions are education and contact. These strategies enhance awareness and understanding of dementia. There has been research exploring people’s knowledge and attitudes towards dementia and people with dementia (PWD). However, what people do not know and therefore would like to learn about dementia has not been explored.Methods:Focus groups were conducted with 1) the general public on what they would like to learn from PWD; and 2) consumers (PWD and carers) on what they would like the general public to know about them and about living with dementia. Thirty one people (3 males and 28 females) aged between 47 and 82 (M1⁄463.7, SD1⁄410.2) participated in six focus groups. They were recruited through local community newspapers. The audio files from the focus groups were transcribed verbatim and transcripts were coded to identify themes using qualitative content analysis. Results: The majority of participants knew/have known someone with dementia and showed some level of understanding on dementia although some lacked basic understanding on dementia making statements such as ‘dementia is different from Alzheimer’s disease’. Participants’ responses could be classified into three distinctive themes: medical, insights, and practical/management. Medical theme included ‘causes of dementia’ and ‘how dementia is diagnosed’. Statements such as ‘what PWD want/need’ and ‘whether PWD know that they have dementia’ sought insights from people living with dementia. Practical or management theme included ‘strategies that can assist in caring for someone with dementia’ and ‘how to behave around PWD’. Conclusions:The findings from the focus groups suggest that the general public want to know not only the medical aspects of dementia, but also the ways/ strategies to better manage the situation and to help/support PWD. They are also keen on learning about what it is like living with dementia. Resources addressing these questions should therefore be available to the general public. The information gathered from these focus groups will be used to develop an online intervention program to reduce dementia-related stigma via having virtual contact with PWD and carers. P2-656 PUBLIC PROFILES IN ALZHEIMER’S DISEASE STIGMA: UNSUPPORTED, DISCRIMINATED, AND ALONE Shana D. Stites, Jonathan D. Rubright, Jason Karlawish, University of Pennsylvania, Philadelphia, PA, USA; National Board of Medical Examiners, Philadelphia, PA, USA. Contact e-mail: stites@upenn.edu

Cancer and Cognitive Function: The PATH Through Life Project

Background A limited number of studies have shown that cancer diagnosis plays a protective role in Alzheimers disease. However, the effect of the cancer diagnosis on general cognitive function/cognitive decline has not been previously examined. The aim of this study was to investigate the relationship between cancer diagnosis and cognitive function and mild cognitive impairment/disorders (MCI/MCD), adjusting for cancer treatments. Methods These data were drawn from the Personality and Total Health (PATH) Through Life Study, a population-based Australian cohort study. A total of 2,547 participants (age range 60-66 years; 48.4% women) who answered cancer-related questions were included in analyses. Random effects linear and logistic models were used to analyze 8-year follow-up data. Results Participants who were diagnosed with cancer at or prior to baseline (n = 166) had higher levels of physical conditions and depression compared with those who received cancer diagnoses during follow-ups (n = 346) and those who reported no cancer history (n = 2,035). A main effect suggested an improvement in processing speed (p < .01), working memory (p < .05), and simple reaction time (p < .05) for those who received the cancer diagnosis after baseline when compared with those without a cancer diagnosis. However, these group differences were no longer significant when adjusted for cancer treatments. Those with a cancer diagnosis at or prior to baseline reported poorer processing speed when compared with those without a cancer diagnosis, even after adjusting for the treatments. Conclusions A cancer diagnosis alone did not play a protective role for cognitive function and cognitive impairment in this population of older community-living individuals.

A PROTOCOL FOR A RANDOMISED CONTROLLED TRIAL OF MULTIDOMAIN DEMENTIA RISK REDUCTION FOR MILD COGNITIVE IMPAIRMENT

0.001, CI95% 1⁄4 [0.872;0.940]). (Figure 3) shows that there was a correlation between the mean scores of the ANU-ADRI test and retest (r 1⁄4 0.918, P < 0.001). The Bland-Altman plot for the two measurements of the ANU-ADRI score is shown in (Figure 4). We noted that in group A, the percentage of individuals with 12 years or more of schooling was lower than group B (P < 0.05). According to (Figure 5), the group A had higher scores of ANU-ADRI than those of group B (P 1⁄4 0.021). Effect size using Cohen’s (d) was 0.469 (IC95% 1⁄4 [0.070;0.865]). According to (Figure 6), there was a moderate negative linear relation between the ANU-ADRI and MEEM scores (r1⁄4 -0.353, P < 0.001) indicating that higher the MMSE score, lower the ANUADRI score (1⁄4 less risk to develop Alzheimer’s disease). Conclusions: We have concluded that low levels of education are related to higher risk scores of the ANU-ADRI. This questionnaire is valid and reliable for use in Brazil.