Intertwined depressive and cognitive trajectories and the risk of dementia and death in older adults:a competing risk analysis

Background Depressive symptoms and cognitive impairment often interact,rendering their associations controversial.To date,their joint trajectories and associations with dementia and death remain underexplored.Aims To explore the interactions between depressive symptoms and cognitive function,their developmental trajectories and the associations with all-cause dementia,Alzheimer’s disease(AD)and all-cause death in older adults.Methods Data were from the Health and Retirement Study.Depressive symptoms and cognitive function were measured using the 8-item Centre for Epidemiologic Studies Depression Scale and the Telephone Interview of Cognitive Status,respectively.All-cause dementia and AD were defined by self-reported or proxy-reported physician diagnoses.All-cause death was determined by interviews.The restricted cubic spline,group-based trajectory modelling and subdistribution hazard regression were used.Results Significant interactions between depressive symptoms and cognitive function in 2010 in their association with new-onset all-cause dementia and AD from 2010 to 2020 were found,especially in women(p for interaction<0.05).Independent trajectory analysis showed that emerging or high(vs no)depressive trajectories and poor or rapidly decreased cognitive trajectories(vs very good)from 1996 to 2010 were at significantly higher risk of subsequent all-cause dementia,AD and all-cause death.15 joint trajectories of depressive symptoms and cognitive function from 1996 to 2010 were determined,where rapidly decreased cognitive function was more common in those with no depressive symptoms.Compared with older adults with the trajectory of no depressive symptoms and very good cognitive function,those with the trajectory of no depressive symptoms but rapidly decreased cognitive function were much more likely to develop new-onset all-cause dementia and death,with subdistribution hazard ratios(95%confidence intervals)of 4.47(2.99 to 6.67)and 1.84(1.43 to 2.36),especially in women.Conclusions To effectively mitigate the risk of dementia and death,it is crucial to acknowledge the importance of preventing cognitive decline in older adults without depressive symptoms,particularly in women.

Adverse childhood experiences from family and society contribute to increased risk of depressive symptoms and cognitive impairment:a cross-sectional study

Background Family environments can shape children’s personalities and social networks,rendering distinguishing adverse childhood experiences(ACEs)from family and society essential,but related evidence remains limited.Aims This cross-sectional study aimed to investigate the correlations between intrafamilial and social ACEs,their associations with depressive symptoms and cognitive impairment and the(education-moderated)mediating role of social ACEs.Methods Data for this cross-sectional study were from the China Health and Retirement Longitudinal Study.Nine intrafamilial(0,1,2,3,and 4 or more)and three social(0,1,and 2 or more)ACEs were identified.Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale.Global cognition,including episodic memory and mental intactness,was calculated as z scores.Binary and ordered logistic regressions,generalised linear models with Gaussian family and identity link,and mediation analysis were used.Results 13435 participants aged 59.0(51.0–66.0)were included.Compared with participants with no intrafamilial ACEs,those with 1,2,3,and 4 or more intrafamilial ACEs tended to develop more social ACEs,with odds ratios(ORs)of 1.55(95%confidence interval(CI):1.36 to 1.76),2.36(95%CI:2.08 to 2.68),3.46(95%CI:3.02 to 3.96)and 6.10(95%CI:5.30 to 7.02),respectively.Both intrafamilial and social ACEs were associated with depressive symptoms(OR>3 for four or more intrafamilial ACEs and two or more social ACEs)and global cognition(β=−0.26 for four or more intrafamilial ACEs andβ=−0.29 for two or more social ACEs).Social ACEs mediated the associations of intrafamilial ACEs with depressive symptoms and global cognition by 12.3%and 13.1%,respectively.Furthermore,as education levels increased,the impact of intrafamilial ACEs on depressive symptoms was increasingly mediated through social ACEs,while the mediating role of social ACEs between intrafamilial ACEs and cognitive impairment gradually diminished.Conclusions Improving children’s social environments and elevating general education can prevent later-life depressive symptoms and cognitive impairment attributed to ACEs in China.

Effect modifications of BMI transition and trajectory in the associations of adverse childhood experiences with new-onset dementia and its subtypes in older US adults

Background Adverse childhood experiences(ACEs)and dementia are associated and comorbid with obesity.However,according to emerging research,the role of obesity in the association between ACEs and dementia seems controversial.Aims This analysis aimed to explore the associations between ACEs and different dementia subtypes and the effect modification of long-term body mass index(BMI).Methods Data were obtained from the US Health and Retirement Study.Six ACEs were categorised as 0,1 and 2 or more.All-cause dementia,Alzheimer’s disease(AD)and other dementias were defined by self-reported or proxy-reported physician diagnosis.Cox proportional hazards regression was used to explore the associations of ACEs with new-onset all-cause dementia,AD and other dementias from 2010 to 2020.Effect modification of BMI in 2010 and BMI transition and trajectory(fitted by group-based trajectory modelling)from 2004 to 2010 were assessed.Results 15282 participants with a mean age of 67.0 years(58.0–75.0)were included in the 2010 data analysis.Significant interactions of ACEs with baseline BMI,BMI transition and BMI trajectory in their associations with new-onset all-cause dementia and AD were observed(all p<0.05).For instance,positive associations of two or more ACEs(vs none)with all-cause dementia and AD were found in those with a BMI trajectory of maintaining≥30 kg/m2(maintain obesity)rather than a decline to or maintaining<25 kg/m2(decline to or maintain normal weight),with hazard ratios(HRs)of 1.87(95%confidence interval(CI):1.45 to 2.42)and 1.85(95%CI:1.22 to 2.80),respectively.Conclusions ACEs were associated with dementia and AD in US adults with long-term abnormally elevated BMI but not with long-term normal or decreasing BMI.Integrated weight management throughout life could prevent dementia among those with childhood adversity.

Developmental Gerontology and Active Population Aging in China

Population aging is an irreversible process in the development of modern society,which brings challenges to comprehensive modernized social governance.Population aging is a“dualistic”development issue that not only leads to aging of the labor force structure but also creates new demographic dividends.This study describes the core thoughts of developmental gerontology(DG),which provides new insight into the relationship between active aging and comprehensive governance for modernized society.The development of DG will provide a feasible and sustainable path to integrate and coordinate the relationship between population aging,society,and economy.

Preventing Birth Defects:Implications and Prospects

Efforts to lower maternal and neonatal mortality rates and enhance the quality of maternal and child care are pivotal,particularly in low-and middle-income countries(LMICs).These initiatives are critical for the realization of the Sustainable Development Goals by 2030.In 2019,congenital anomalies ranked as the tenth leading cause of global health loss(1).These conditions,also known as birth defects(BDs).

Temporal Trends of Clinical Characteristics and Treatments in People Living with HIV at the Initiation of Antiretroviral Therapy — Beijing Municipality, China, 2010–2020

Summary What is already known about this topic?Antiretroviral therapy(ART)eligibility criteria and treatment regimens were updated in national guidelines.However,whether treatment was timely and followed guidelines was under-assessed.

A Hospital-Based Study on Congenital Heart Defects—Haidian District,Beijing Municipality,China,2013–2022

Summary What is already known about this topic?Congenital heart defects(CHDs)represent the most prevalent birth defects in China,exhibiting significant mortality and morbidity rates.Recent years have witnessed a steady increase in the occurrence of CHDs,highlighting a crucial need for rigorous research focus.

Periconceptional Folic Acid Use and Its Effects on Neural Tube Defects—Five Counties,Shanxi Province,China,2010–2016

Summary What is already known about this topic?Robust evidence indicates that supplementing with folic acid periconceptionally may decrease the risk of neural tube defects(NTDs)in fetuses.What is added by this report?Over half of the mothers in both the NTD case group and the control group utilized folic acid supplements during the periconceptional period,showing no notable variations between the two groups.

Healthy Lifestyles and Chronic Pain with New-Onset Metabolic-Related Multimorbidity among Older Adults—China,2011–2018

Summary What is already known about this topic?Chronic pain has been identified as a risk factor for cardiovascular diseases.Evidence shows that adopting a healthy lifestyle can help reduce the cardiometabolic risks associated with chronic pain.What is added by this report?Results from this cohort study suggest a positive association between chronic pain and the development of new-onset metabolic-related multimorbidity,specifically metabolic multimorbidity and cardiometabolic comorbidity,within middle-aged and older Chinese adults.Furthermore,adopting healthy lifestyles can potentially mitigate or even reverse these associations.What are the implications for public health practice?The results of our study emphasize the importance of promoting healthy lifestyles among older Chinese adults as a preventative measure against the medical burdens and cardiometabolic risks associated with chronic pain.

Prevalence and Trends of Birth Defects—Five Counties,Shanxi Province,China,2003–2022

Summary What is already known about this topic?The Shanxi Province,located in northern China,holds the highest prevalence of birth defects(BDs)across the country.Following the implementation of a nationwide folic acid supplementation program in 2009,a significant reduction of 53.89%in the prevalence of neural tube defects(NTDs)was observed in Shanxi from 2012 to 2017.

Trends in the Prevalence of Births with Chromosomal Abnormalities—Haidian District,Beijing Municipality,China,2013–2022

Summary What is already known about this topic?The primary causes of early miscarriage and stillbirth are chromosomal abnormalities(CAs)whose prevalence has been observed to increase in recent years.What is added by this report?According to data received from a hospital-based birthdefect surveillance system in the Haidian District,Beijing,there was a significant increase in the prevalence of CAs along with most subtypes from 2013 to 2022.

Periconceptional Folic Acid Only Versus Multiple Micronutrients Containing Folic Acid and Association with Gestational Diabetes Mellitus-Beijing Municipality,China,2017-2021

Summary What is already known about this topic?Inconsistent results have been reported on the association between periconceptional folic acid only(FAO)or multiple micronutrients containing folic acid(MMFA)supplementation and the risk of gestational diabetes mellitus(GDM)in previous research.What is added by this report?In a prospective cohort study conducted among pregnant women in Haidian District,Beijing Municipality,it was observed that those who took MMFA demonstrated a higher likelihood of developing GDM in comparison to those who consumed FAO periconceptionally.Interestingly,the increased risk for GDM in pregnant women supplemented with MMFA compared to FAO was primarily due to changes in fasting plasma glucose.What are the implications for public health practice?It is highly recommended that women prioritize the use of FAO in order to yield potential benefits in the prevention of GDM.

Prevalence of Metabolic Syndrome and Risk Factors Among Chinese Adults:Results from a Population-Based Study—Beijing,China,2017–2018

Summary What is already known about this topic?Metabolic syndrome(MetS)is one of the most easily available health indicative markers for cardiovascular diseases,and it has become a major public health problem worldwide due to increasing urbanization and aging populations.The prevalence of MetS increased dramatically in China,however,there are no records of MetS defined by the 2017 Chinese Diabetes Society for Beijing by far.What is added by this report?In this study,the data of 24,412 participants aged 18–74 years from a large population-based study in Beijing was collected.The overall prevalence of MetS among Beijing residents was 24.5%.The prevalence was 35.2%in males and 15.4%in females.What are the implications for public health practice?Effective public health strategies should target males,people with older age,lower education,higher body mass index,smokers,those who drink alcohol,those who are unemployed or retired,and those who live in rural areas on MetS prevention and control.

Passive Smoking During the Periconceptional Period and Risk for Neural Tube Defects in Offspring—Five Counties,Shanxi Province,China,2010–2016

Summary What is already known about this topic?Passive smoking during pregnancy,which is prevalent in China,has been reported to be associated with an increased risk for neural tube defects(NTDs)in five counties of Shanxi Province in northern China.What is added by this report?After 4 years since the implementation of the World Health Organization(WHO)Framework Convention on Tobacco Control(FCTC)in China.

Orofacial Clefts in High Prevalence Area of Birth Defects—Five Counties,Shanxi Province,China,2000–2020

Summary What is already known on this topic?The prevalence of structural birth defects,especially neural tube defects,decreased after national folic acid(FA)supplementation initiation.What is added by this report?The prevalence of orofacial clefts(OFCs)in five counties of Shanxi Province in northern China,including most subtypes except cleft palate,showed a downward trend in the past two decades.In this study,pre-perinatal prevalence increased due to earlier detection.

Selected Structural Birth Defects--Shanxi Province,China,2000−2019

What is already known about this topic?To reduce the high prevalence of neural tube defects(NTDs)in rural areas of the country,the Ministry of Health of China(currently known as the National Health Commission)initiated a nationwide folic acid supplementation program in 2009.The prevalence of NTDs have decreased from 118.9/10,000 births to 31.5/10,000 in northern China from 2000 to 2014.What is added by this report?Based on a population-based birth-defect surveillance system,the prevalence of selected structural birth defects in 5 counties in northern China decreased significantly from 182.8/10,000 births to 119.3/10,000 during the past two decades.Perinatal(28 gestational weeks or more)structural birth defects decreased from 83.9%of total birth defects in 2000 to 59.9%in 2019.What are the implications for public health practice?Improving the compliance of periconceptional folic acid supplementation,the fortification of staple foods with folic acid,and the health education surrounding early prenatal check-ups should be considered to further reduce the risk of birth defects in the population.