117 results found
Peters R, Peters J, Booth A, et al., 2019, Trajectory of blood pressure, body mass index, cholesterol and incident dementia: systematic review., Br J Psychiatry, Pages: 1-13
BACKGROUND: The global ageing population and the long prodromal period for the development of cognitive decline and dementia brings a need to understand the antecedents of both successful and impaired cognitive ageing. It is increasingly apparent that the trajectory of risk-factor change, as well as the level of the risk factor, may be associated with an increased or decreased risk of cognitive decline or dementia.AimsOur aim was to summarise the published evidence and to generate hypotheses related to risk-factor trajectories and risk of incident cognitive decline or dementia. METHOD: We collated data from longitudinal observational studies relating to trajectory of blood pressure, obesity and cholesterol and later cognitive decline or dementia using standard systematic review methodology. The databases MEDLINE, Embase and PsycINFO were searched from inception to 26 April 2018. RESULTS: Thirteen articles were retained for inclusion. Analytical methods varied. Our summary of the current evidence base suggests that first body mass index and then blood pressure rises and then falls more steeply in those who go on to develop dementia. The evidence for cholesterol was less consistent. CONCLUSION: Based on our review we present the hypothesis that weight falls around 10 years and blood pressure around 5 years before diagnosis. Confirmatory work is required. However, characterisation of risk according to combinations and patterns of risk factors may ultimately be integrated into the assessments used to identify those at risk of receiving a diagnosis of cognitive decline or dementia in late life.Declaration of interestNone.
Peters R, Warwick J, Anstey KJ, et al., 2019, Blood pressure and dementia: What the SPRINT-MIND trial adds and what we still need to know., Neurology, Vol: 92, Pages: 1017-1018
Tully PJ, Helmer C, Peters R, et al., 2019, Exploiting Drug-Apolipoprotein E Gene Interactions in Hypertension to Preserve Cognitive Function: The 3-City Cohort Study, JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION, Vol: 20, Pages: 188-+, ISSN: 1525-8610
Peters R, Beckett N, Antikainen R, et al., 2019, Subjective memory complaints and incident dementia in a high risk older adult hypertensive population, AGE AND AGEING, Vol: 48, Pages: 253-259, ISSN: 0002-0729
Peters R, 2019, No clear relationship between antihypertensive class and cognitive function over 12 months in a cohort study of community-dwelling adults aged 80 and over, THERAPEUTIC ADVANCES IN CHRONIC DISEASE, Vol: 10, Pages: 1-9, ISSN: 2040-6223
Peters R, Booth A, Rockwood K, et al., 2019, Combining modifiable risk factors and risk of dementia: a systematic review and meta-analysis, BMJ Open, Vol: 9, ISSN: 2044-6055
OBJECTIVE: To systematically review the literature relating to the impact of multiple co-occurring modifiable risk factors for cognitive decline and dementia. DESIGN: A systematic review and meta-analysis of the literature relating to the impact of co-occurring key risk factors for incident cognitive decline and dementia. All abstracts and full text were screened independently by two reviewers and each article assessed for bias using a standard checklist. A fixed effects meta-analysis was undertaken. DATA SOURCES: Databases Medline, Embase and PsycINFO were searched from 1999 to 2017. ELIGIBILITY CRITERIA: For inclusion articles were required to report longitudinal data from participants free of cognitive decline at baseline, with formal assessment of cognitive function or dementia during follow-up, and an aim to examine the impact of additive or clustered comorbid risk factor burden in with two or more core modifiable risk factors. RESULTS: Seventy-nine full-text articles were examined. Twenty-two articles (18 studies) were included reporting data on >40 000 participants. Included studies consistently reported an increased risk associated with greater numbers of intraindividual risk factors or unhealthy behaviours and the opposite for healthy or protective behaviours. A meta-analysis of studies with dementia outcomes resulted in a pooled relative risk for dementia of 1.20 (95% CI 1.04 to 1.39) for one risk factor, 1.65 (95% CI 1.40 to 1.94) for two and 2.21 (95% CI 1.78 to 2.73) for three or more, relative to no risk factors. Limitations include dependence on published results and variations in study outcome, cognitive assessment, length of follow-up and definition of risk factor exposure. CONCLUSIONS: The strength of the reported associations, the consistency across studies and the suggestion of a dose response supports a need to keep modifiable risk factor exposure to a minimum and to avoid exposure to additional modifiable risks. Further research is ne
Peters R, Ee N, Peters J, et al., 2019, Common risk factors for major noncommunicable disease, a systematic overview of reviews and commentary: the implied potential for targeted risk reduction, Therapeutic Advances in Chronic Disease, Vol: 10, Pages: 204062231988039-204062231988039, ISSN: 2040-6223
<jats:p> Noncommunicable disease now contributes to the World Health Organization top 10 causes of death in low-, middle- and high-income countries. Particular examples include stroke, coronary heart disease, dementia and certain cancers. Research linking clinical and lifestyle risk factors to increased risk of noncommunicable disease is now well established with examples of confirmed risk factors, including smoking, physical inactivity, obesity and hypertension. However, despite a need to target our resources to achieve risk reduction, relatively little work has examined the overlap between the risk factors for these main noncommunicable diseases. Our high-level review draws together the evidence in this area. Using a systematic overview of reviews, we demonstrate the likely commonality of established risk factors having an impact on multiple noncommunicable disease outcomes. For example, systematic reviews of the evidence on physical inactivity and poor diet found each to be associated with increased risk of cancers, coronary heart disease, stroke, diabetes mellitus and dementia. We highlight the potential for targeted risk reduction to simultaneously impact multiple noncommunicable disease areas. These relationships now need to be further quantified to allow the most effective development of public health interventions in this area. </jats:p>
Anstey KJ, Peters R, 2019, Dementia, Risk, Risk Reduction, and Translation into Practice: An International Research Network for Dementia Prevention (IRNDP) Special Issue., J Alzheimers Dis, Vol: 70, Pages: S1-S3
BACKGROUND: Both air pollution and dementia are current and growing global issues. There are plausible links between exposure to specific air pollutants and dementia. OBJECTIVE: To systematically review the evidence base with respect to the relationship between air pollution and later cognitive decline and dementia. METHODS: Medline, Embase, and PsychINFO® were searched from their inception to September 2018, for publications reporting on longitudinal studies of exposure to air pollution and incident dementia or cognitive decline in adults. Studies reporting on exposure to tobacco smoke including passive smoking or on occupational exposure to pollutants were excluded. Using standard Cochrane methodology, two readers identified relevant abstracts, read full text publications, and extracted data into structured tables from relevant papers, as defined by inclusion and exclusion criteria. Papers were also assessed for validity. CRD42018094299Results:From 3,720 records, 13 papers were found to be relevant, with studies from the USA, Canada, Taiwan, Sweden, and the UK. Study follow-up ranged from one to 15 years. Pollutants examined included particulate matter ≤2.5 μ (PM2.5), nitrogen dioxide (NO2), nitrous oxides (NOx), carbon monoxide (CO), and ozone. Studies varied in their methodology, population selection, assessment of exposure to pollution, and method of cognitive testing. Greater exposure to PM2.5, NO2/NOx, and CO were all associated with increased risk of dementia. The evidence for air pollutant exposure and cognitive decline was more equivocal. CONCLUSION: Evidence is emerging that greater exposure to airborne pollutants is associated with increased risk of dementia.
Anstey KJ, Ee N, Eramudugolla R, et al., 2019, A Systematic Review of Meta-Analyses that Evaluate Risk Factors for Dementia to Evaluate the Quantity, Quality, and Global Representativeness of Evidence., J Alzheimers Dis, Vol: 70, Pages: S165-S186
BACKGROUND: The translation of evidence on dementia risk factors into clinical advice requires careful evaluation of the methodology and scope of data from which risk estimates are obtained. OBJECTIVE: To evaluate the quantity, quality, and representativeness of evidence, we conducted a review of reviews of risk factors for Alzheimer's disease (AD), Vascular dementia (VaD), and Any Dementia. METHODS: PubMed, Cochrane library, and the Global Index Medicus were searched to identify meta-analyses of observational studies of risk factors for AD, VaD, and Any Dementia. PROSPERO CRD42017053920. RESULTS: Meta-analysis data were available for 34 risk factors for AD, 26 risk factors for Any Dementia and eight for VaD. Quality of evidence varied greatly in terms of the number of contributing studies, whether data on midlife exposure was available, and consistency of measures. The most evidence was available for cardiovascular risk factors. The most geographically representative evidence (five of six global regions) was available for alcohol, physical activity, diabetes, high midlife BMI, antihypertensives, and motor function. Evidence from Australia/Oceana or Africa was limited. With the exception of diabetes, meta-analysis data were unavailable from Latin America/Caribbean. Midlife specific data were only available for cholesterol and arthritis. CONCLUSION: There is a lack of midlife specific data, limited data on VaD, and a lack of geographical representation for many risk factors for dementia. The quality, quantity, and representativeness of evidence needs to be considered before recommendations are made about the relevance of risk factors in mid- or late-life or for dementia subtypes.
Hosking DE, Ayton S, Beckett N, et al., 2018, More evidence is needed. Iron, incident cognitive decline and dementia: a systematic review, THERAPEUTIC ADVANCES IN CHRONIC DISEASE, Vol: 9, Pages: 241-256, ISSN: 2040-6223
Anstey KJ, Peters R, 2018, Alcohol and dementia - risk or protective factor?, NATURE REVIEWS NEUROLOGY, Vol: 14, Pages: 635-636, ISSN: 1759-4758
Tully PJ, Turnbull DA, Anstey KJ, et al., 2018, The association between blood pressure variability (BPV) with dementia and cognitive function: a systematic review and meta-analysis protocol, SYSTEMATIC REVIEWS, Vol: 7
Peters R, Anstey KJ, Booth A, et al., 2018, Orthostatic hypotension and symptomatic subclinical orthostatic hypotension increase risk of cognitive impairment: an integrated evidence review and analysis of a large older adult hypertensive cohort, EUROPEAN HEART JOURNAL, Vol: 39, Pages: 3135-3143, ISSN: 0195-668X
Tully PJ, Peters R, Peres K, et al., 2018, Effect of SSRI and calcium channel blockers on depression symptoms and cognitive function in elderly persons treated for hypertension: three city cohort study, INTERNATIONAL PSYCHOGERIATRICS, Vol: 30, Pages: 1345-1354, ISSN: 1041-6102
Mortby ME, Peters R, 2018, Greater cognitive decline relative to normal ageing occurs at least 10 years prior to clinical dementia diagnosis., BMJ Evid Based Med, Vol: 23
Skrobot OA, Black SE, Chen C, et al., 2018, Progress toward standardized diagnosis of vascular cognitive impairment: Guidelines from the Vascular Impairment of Cognition Classification Consensus Study, ALZHEIMERS & DEMENTIA, Vol: 14, Pages: 280-292, ISSN: 1552-5260
Anstey KJ, Peters R, 2018, Oversimplification of Dementia Risk Reduction Messaging Is a Threat to Knowledge Translation in Dementia Prevention Research, JPAD-JOURNAL OF PREVENTION OF ALZHEIMERS DISEASE, Vol: 5, Pages: 2-4, ISSN: 2274-5807
Anstey KJ, Peters R, Clare L, et al., 2017, Joining forces to prevent dementia: The International Research Network On Dementia Prevention (IRNDP), INTERNATIONAL PSYCHOGERIATRICS, Vol: 29, Pages: 1757-1760, ISSN: 1041-6102
Malhotra R, Hoang AN, Benavente O, et al., 2017, Association Between More Intensive vs Less Intensive Blood Pressure Lowering and Risk of Mortality in Chronic Kidney Disease Stages 3 to 5 A Systematic Review and Meta-analysis, JAMA INTERNAL MEDICINE, Vol: 177, Pages: 1498-1505, ISSN: 2168-6106
Skrobot OA, O'Brien J, Black S, et al., 2017, The Vascular Impairment of Cognition Classification Consensus Study, ALZHEIMERS & DEMENTIA, Vol: 13, Pages: 624-633, ISSN: 1552-5260
Bulpitt CJ, Webb R, Beckett N, et al., 2017, Antihypertensive treatment decreases arterial stiffness at night but not during the day. Results from the Hypertension in the Very Elderly Trial, BLOOD PRESSURE, Vol: 26, Pages: 109-114
Anstey KJ, Ashby-Mitchell K, Peters R, 2017, Updating the Evidence on the Association between Serum Cholesterol and Risk of Late-Life Dementia: Review and Meta-Analysis, JOURNAL OF ALZHEIMERS DISEASE, Vol: 56, Pages: 215-228, ISSN: 1387-2877
Antikainen RL, Peters R, Beckett NS, et al., 2016, Left ventricular hypertrophy is a predictor of cardiovascular events in elderly hypertensive patients: Hypertension in the Very Elderly Trial, JOURNAL OF HYPERTENSION, Vol: 34, Pages: 2280-2286, ISSN: 0263-6352
Yasar S, Schuchman M, Peters J, et al., 2016, Relationship between antihypertensive medications and cognitive impairment: Part I. review of human studies and clinical trials, Current Hypertension Reports, Vol: 18, ISSN: 1534-3111
Purpose of review:There is an established association between hypertension and increased risk of poor cognitive performance and dementia including Alzheimer’s disease; however, associations between antihypertensive medications (AHMs) and dementia risk are less consistent. An increased interest in AHM has resulted in expanding publications; however, none of the recent reviews are comprehensive. Our extensive review includes 15 observational and randomized controlled trials (RCTs) published over the last 5 years, assessing the relationship between AHM and cognitive impairment.Recent findings:All classes of AHM showed similar result patterns in human studies with the majority of study results reporting point estimates below one and only a small number of studies (N = 15) reporting statistically significant results in favor of a specific class.Summary:Only a small number of studies reported statistically significant results in favor of a specific class of AHM. Methodological limitations of the studies prevent definitive conclusions. Further work is now needed to evaluate the class of AHM and cognitive outcomes in future RCTs, with a particular focus on the drugs with the promising results in both animals and human observational studies.
Peters R, Schuchman M, Peters J, et al., 2016, Relationship between antihypertensive medications and cognitive impairment: Part II. Review of Physiology and animal studies, Current Hypertension Reports, Vol: 18, ISSN: 1534-3111
Purpose of ReviewThere is an established association between hypertension and increased risk of poor cognitive performance and dementia including Alzheimer’s disease; however, associations between antihypertensive medications (AHM) and dementia risk are less clear. An increased interest in AHM has resulted in expanding publications; however, none of the recent reviews provide comprehensive review. Our extensive review includes 24 mechanistic animal and human studies published over the last 5 years assessing relationship between AHM and cognitive function.Recent FindingsAll classes of AHM showed similar result patterns in animal studies. The mechanism by which AHM exert their effect was extensively studied by evaluating well-established pathways of AD disease process, including amyloid beta (Aβ), vascular, oxidative stress and inflammation pathways, but only few studies evaluated the blood pressure lowering effect on the AD disease process.SummaryMethodological limitations of the studies prevent comprehensive conclusions prior to further work evaluating AHM in animals and larger human observational studies, and selecting those with promising results for future RCTs.
Pedditzi E, Peters R, Beckett N, 2016, Corrigendum to 'The risk of overweight/obesity in mid-life and late life for the development of dementia: a systematic review and meta-analysis of longitudinal studies', Age and Ageing, ISSN: 1468-2834
Chatterjee S, Peters SAE, Woodward M, et al., 2016, Type 2 Diabetes as a Risk Factor for Dementia in Women Compared With Men: A Pooled Analysis of 2.3 Million People Comprising More Than 100,000 Cases of Dementia, Diabetes Care, Vol: 39, Pages: 300-307, ISSN: 1935-5548
OBJECTIVE Type 2 diabetes confers a greater excess risk of cardiovascular disease in women than in men. Diabetes is also a risk factor for dementia, but whether the association is similar in women and men remains unknown. We performed a meta-analysis of unpublished data to estimate the sex-specific relationship between women and men with diabetes with incident dementia.RESEARCH DESIGN AND METHODS A systematic search identified studies published prior to November 2014 that had reported on the prospective association between diabetes and dementia. Study authors contributed unpublished sex-specific relative risks (RRs) and 95% CIs on the association between diabetes and all dementia and its subtypes. Sex-specific RRs and the women-to-men ratio of RRs (RRRs) were pooled using random-effects meta-analyses.RESULTS Study-level data from 14 studies, 2,310,330 individuals, and 102,174 dementia case patients were included. In multiple-adjusted analyses, diabetes was associated with a 60% increased risk of any dementia in both sexes (women: pooled RR 1.62 [95% CI 1.45–1.80]; men: pooled RR 1.58 [95% CI 1.38–1.81]). The diabetes-associated RRs for vascular dementia were 2.34 (95% CI 1.86–2.94) in women and 1.73 (95% CI 1.61–1.85) in men, and for nonvascular dementia, the RRs were 1.53 (95% CI 1.35–1.73) in women and 1.49 (95% CI 1.31–1.69) in men. Overall, women with diabetes had a 19% greater risk for the development of vascular dementia than men (multiple-adjusted RRR 1.19 [95% CI 1.08–1.30]; P < 0.001).CONCLUSIONS Individuals with type 2 diabetes are at ∼60% greater risk for the development of dementia compared with those without diabetes. For vascular dementia, but not for nonvascular dementia, the additional risk is greater in women.
Pedditizi E, Peters R, Beckett N, 2016, The risk of overweight/obesity in mid-life and late life for the development of dementia: a systematic review and meta-analysis of longitudinal studies, Age and Ageing, Vol: 45, Pages: 14-21, ISSN: 1468-2834
Scope: it has been suggested that overweight/obesity as a risk factor for incident dementia differs between mid-life and later life. We performed a systematic review and meta-analysis of the up-to-date current literature to assess this.Search Methods: inclusion criteria included epidemiological longitudinal studies published up to September 2014, in participants without cognitive impairment based on evidence of cognitive assessment and aged 30 or over at baseline assessment with at least 2 years of follow-up. Pubmed, Medline, EMBASE, PsychInfo and the Cochrane Library were searched using combinations of the search terms: Dementia, Alzheimer disease, Vascular Dementia, Multi-Infarct Dementia, Cognitive decline, Cognitive impairment, Mild Cognitive Impairment/Obesity, Overweight, Adiposity, Waist circumference (limits: humans, English language). Handsearching of all papers meeting the inclusion criteria was performed. A random-effects model was used for the meta-analysis.Results: of the 1,612 abstracts identified and reviewed, 21 completely met the inclusion criteria. Being obese below the age of 65 years had a positive association on incident dementia with a risk ratio (RR) 1.41 (95% confidence interval, CI: 1.20–1.66), but the opposite was seen in those aged 65 and over, RR 0.83 (95% CI: 0.74–0.94).Conclusions: this systematic review and meta-analysis suggests a positive association between obesity in mid-life and later dementia but the opposite in late life. Whether weight reduction in mid-life reduces risk is worthy of further study.
Hallgreen CE, Mt-Isa S, Lieftucht A, et al., 2015, Literature review of visual representation of the results of benefit-risk assessments of medicinal products, Pharmacoepidemiology and Drug Safety, Vol: 25, Pages: 238-250, ISSN: 1099-1557
BackgroundThe PROTECT Benefit–Risk group is dedicated to research in methods for continuous benefit–risk monitoring of medicines, including the presentation of the results, with a particular emphasis on graphical methods.MethodsA comprehensive review was performed to identify visuals used for medical risk and benefit–risk communication. The identified visual displays were grouped into visual types, and each visual type was appraised based on five criteria: intended audience, intended message, knowledge required to understand the visual, unintentional messages that may be derived from the visual and missing information that may be needed to understand the visual.ResultsSixty-six examples of visual formats were identified from the literature and classified into 14 visual types. We found that there is not one single visual format that is consistently superior to others for the communication of benefit–risk information. In addition, we found that most of the drawbacks found in the visual formats could be considered general to visual communication, although some appear more relevant to specific formats and should be considered when creating visuals for different audiences depending on the exact message to be communicated.ConclusionWe have arrived at recommendations for the use of visual displays for benefit–risk communication. The recommendation refers to the creation of visuals. We outline four criteria to determine audience–visual compatibility and consider these to be a key task in creating any visual. Next we propose specific visual formats of interest, to be explored further for their ability to address nine different types of benefit–risk analysis information. Copyright © 2015 John Wiley & Sons, Ltd.
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